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Dehiscence refers to the unplanned or spontaneous opening of a surgical wound after it has been closed with sutures or other methods. Although it is a rare complication after skin surgery, dehiscence has been noted to occur for a number of reasons.
A healing wound, especially early in the post-operative period, is not as strong as normal skin. “When pressure is applied to a delicate area that has been stitched together, dehiscence can take place,” says Dr. Adam Mamelak, a board-certified Dermatologist and Mohs Micrographic Surgeon in Austin, Texas. This pressure, of course, can come from a variety of sources. Vigorous activity and excessive movement are discouraged after surgery to help ensure optimal healing. Bleeding or the development of a hematoma under the skin can put pressure on a surgical wound causing it to open. “This can also occur is a patient develops an infection at their incision site.” Taking it easy and following the doctor’s post-operative wound care instructions are the best ways to avoid dehiscence and any other complications.
Dehiscence can happen to any wound, but there are a few factors that can increase your risk. “Younger patients, especially those with a very active lifestyle, are probably more likely to experience this type of complication,” says Dr. Mamelak. “I see this in wounds located on the back, arms or legs, where there is a lot of movement and stretch.” Some patients react to the stitches placed under their skin, causing them to spit or be exuded through the skin surface, potentially opening the surgical wound.
An impaired blood supply might also not deliver the nutrients a wound needs for optimal healing, leading to necrosis and hence causing a wound to open. This can occur if a wound is sutured to tightly or if the skin is overstretched to reconstruct the wound. “However, I think the most common scenario is tobacco. Smoking is probably the number one thing that I see that effects wound healing,” says Dr. Mamelak.
Dr. Mamelak performs skin cancer surgery at Sanova Dermatology and the Austin Mohs Surgery Centerwhere he treats patients young and old, from different background and with a full spectrum of medical conditions.
Taking extra care to prevent any unnecessary stretching or pulling of the skin is a great way to ensure that your surgical wound does not dehiss during the healing process. “With a few stitches in the skin, patients often feel like they didn’t have medical procedure. But it’s still surgery!” says Dr. Mamelak. “Patients need to remember to rest and convalesce to get the best results.” It may not always be possible to follow post-procedure instructions to the letter, but staying as close as you can to the aftercare instructions is always encouraged.
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Are you scheduled to undergo Mohs surgery for skin cancer or another skin surgery? Contact us today. The physicians at Sanova Dermatology can help you prepare for your procedure, and assist you with any complications or concerns.