Abdominal wound dehiscence (AWD) represents a critical postoperative complication that continues to challenge surgical practice due to its association with high rates of morbidity, mortality, and healthcare burden [1]. Defined as the partial or complete disruption of a surgical wound, AWD occurs when the integrity of the abdominal wall is compromised due to failure in tissue strength or excessive mechanical stress. Complete dehiscence, which may result in visceral evisceration, is particularly catastrophic and demands immediate surgical intervention. Reported incidence ranges from 0.2% to 6%, with associated mortality reaching as high as 44% [2].

The etiology of AWD is multifactorial, encompassing both patient-related and surgery-related factors. Pre-existing comorbid conditions such as diabetes mellitus, malnutrition, anemia, jaundice, or renal failure, as well as factors like advanced age and male sex, have been correlated with increased risk [3]. Operative variables including emergency surgery, prolonged operative time, surgical site infection (SSI), and postoperative conditions like increased intra-abdominal pressure further exacerbate vulnerability to wound failure [4]. Despite improvements in surgical techniques, asepsis, and suture materials, the global incidence of AWD remains largely unchanged [5].

Given the ongoing clinical challenge posed by AWD, especially among adult surgical patients, and the socioeconomic impact in resource-limited settings, this study aims to systematically evaluate the incidence, clinicopathological correlates, and contributing risk factors for abdominal wound dehiscence.

Aims, Objectives and Materials & Methods

This study aimed to investigate the incidence, risk factors, and clinical outcomes associated with abdominal wound dehiscence (AWD) in adult surgical patients. The primary objective was to identify and analyze both predisposing and precipitating factors that contribute to AWD following laparotomies. A prospective observational study was conducted at the Department of Surgery, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, over a period of one year. A total of 50 adult patients who developed wound dehiscence following laparotomy and required resuturing were enrolled. Detailed demographic, clinical, surgical, and laboratory data were collected. Descriptive statistics and comparative analyses were applied using SPSS software to evaluate significant risk factors influencing wound dehiscence.

The study included 50 patients, with a male predominance (74%). The most common age group affected was 41–50 years (34%). Emergency surgeries comprised 68% of cases, with perforation peritonitis (40%) being the leading surgical indication (Table 1).

Operatively, 80% of patients had midline incisions, and dehiscence most commonly occurred around postoperative day 7. Complete wound dehiscence was observed in 60% of cases (Table 2).

Microbiologically, Staphylococcus aureus (45%) was the most frequent isolate. Post-resuturing, wound infection was noted in 30% of patients, and the mortality rate was 14%, predominantly due to sepsis (Table 3).

Reformatted table 1: demographic and clinical profile

Reformatted table 2: operative and postoperative factors

Reformatted table 3: outcomes and mortality analysis

Abdominal wound dehiscence (AWD) remains a devastating complication following laparotomy, leading to significant morbidity, mortality, and financial burden on healthcare systems. In the present study, the overall incidence of AWD was consistent with the global reported range of 0.2% to 6% [1]. Our findings underscore several crucial demographics, operative, and postoperative factors influencing wound dehiscence.

In alignment with previous studies, males were more frequently affected than females [2]. This male predominance has been attributed to factors such as higher rates of emergency surgeries, poor nutritional status, and increased abdominal muscle mass, which exerts higher tension on sutured wounds [3]. The most affected age group was 41–50 years, coinciding with similar studies that identify the fourth and fifth decades as peak incidence periods [4].

Emergency surgeries were significantly associated with AWD in our cohort. Emergency settings often preclude optimal patient preparation, resulting in uncorrected anemia, sepsis, and hypoproteinemia—all of which contribute to impaired wound healing [5]. Perforation peritonitis, which was the leading surgical indication in our study (40%), inherently carries a higher risk due to contamination and septic load [6].

Operative factors were equally critical. Midline incisions, although convenient and widely used, have been shown to have a higher predisposition to dehiscence compared to transverse incisions [7]. Our findings further substantiate this, with 80% of dehiscence cases occurring in midline laparotomy wounds. Interrupted suturing was predominantly utilized; however, suture technique alone does not fully mitigate the risk without addressing underlying systemic factors.

The microbiological profile in our study identified Staphylococcus aureus as the predominant organism, followed by Escherichia coli. This is consistent with literature indicating that gram-positive cocci and gram-negative bacilli are frequent culprits in surgical site infections [8]. Wound infection remains a major contributor to mechanical failure of wound healing, and hence, to dehiscence [9].

Mortality in cases of AWD remains alarmingly high. In the present study, mortality was 14%, with sepsis being the principal cause. These figures corroborate reports from previous literature suggesting that mortality rates in AWD patients range from 10% to 44% depending on the severity of infection, patient comorbidities, and timeliness of surgical intervention [10].

Notably, despite appropriate surgical management using tension suturing and retention techniques, a considerable proportion of patients (30%) developed wound infections post-resuturing, and 10% developed incisional hernias. This highlights the need for rigorous postoperative care, early detection of complications, and consideration of prophylactic measures such as use of mesh reinforcement in high-risk patients [11].

Comparative analysis with other regional and international studies reveals that systemic factors such as malnutrition, diabetes, and infection remain consistently implicated across populations [12]. However, institution-specific factors including surgical expertise, resource availability, and perioperative protocols also play a pivotal role.

Abdominal wound dehiscence is a complex, multifactorial complication associated with high morbidity and mortality. Meticulous surgical technique, early identification of risk factors, aggressive infection control, and adequate perioperative care are essential to minimize its occurrence and impact on surgical outcomes.

1. Jenkins, T.P. "The Burst Abdominal Wound: A Mechanical Approach." British Journal of Surgery, vol. 63, no. 11, 1976, pp. 873–876

2. van Ramshorst, G.H., et al. "Abdominal Wound Dehiscence in Adults: Development and Validation of a Risk Model." World Journal of Surgery, vol. 34, no. 1, 2010, pp. 20–27

3. Israelsson, L.A., et al. "Abdominal Wound Dehiscence: A Prospective Study of Risk Factors." Surgery, vol. 113, no. 3, 1993, pp. 329–332.

4. van 't Riet, M., et al. "Prevention of Wound Dehiscence by a New Suture Technique: Experimental Study in Piglets." World Journal of Surgery, vol. 28, no. 4, 2004, pp. 411–415.

5. Carlson, M.A. "Acute Wound Failure." Surgical Clinics of North America, vol. 77, no. 3, 1997, pp. 607–636.

6. Leaper, D.J. "Surgical-Site Infection." British Journal of Surgery, vol. 97, no. 11, 2010, pp. 1601–1602.

7. Grantcharov, T.P., et al. "Incisional Hernia After Open and Laparoscopic Surgery: A Systematic Review and Meta-Analysis." Surgery, vol. 131, no. 5, 2002, pp. 464–477.

8. Awad, S.S. "Adherence to Surgical Care Improvement Project Measures and Post-Operative Surgical Site Infections." Surgical Infections (Larchmont), vol. 13, no. 4, 2012, pp. 234–237.

9. Shah, J., et al. "Factors Affecting Wound Healing." American Family Physician, vol. 72, no. 11, 2005, pp. 2192–2199.

10. Niggebrugge, A.H., et al. "Incidence and Prevention of Incisional Hernia Following Wound Infection." British Journal of Surgery, vol. 82, no. 8, 1995, pp. 1113–1115

11. Sugerman, H.J., et al. "Prevention of Wound Dehiscence by Retention Sutures." American Journal of Surgery, vol. 147, no. 3, 1984, pp. 376–382.

12. Johl, A.K., et al. "Abdominal Wound Dehiscence: Still a Grave Surgical Problem." International Journal of Research in Medical Sciences, vol. 5, no. 9, 2017, pp. 3881–3886.