Prevention, identification and management of Surgical Wound Dehiscence (SWD)

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Prevention, identification and management of Surgical Wound Dehiscence (SWD)

Supported by Smith and Nephew
Andrew Sharpe, Fiona Downie, Heidi Sandoz, Jeanette Milne, Kylie Sandy-Hodgetts, Melissa Rochon, Rhidian Morgan-Jones
16 October 2023


Surgical wound dehiscence (SWD) is a serious post-operative complication that affects patients, clinicians, and the wider community (Sandy-Hodgetts et al, 2013). Surgical wound complications (SWCs) in general have been shown to delay healing and result in significant morbidity and mortality, as well as increase demands on clinicians’ time with related socioeconomic costs (Sandy-Hodgetts et al, 2020a). The impact of SWD can be substantial and lead to increased mortality, delayed hospital discharge, readmission, further surgery, delayed adjuvant treatment, suboptimal aesthetic outcome and impaired psychosocial wellbeing (Sandy-Hodgetts et al, 2016; World Union of Wound Healing Societies [WUWHS], 2018).

The impact of SWD is almost certainly underreported and there is lack of a standard definition for SWD. It is therefore vital to raise awareness and improve early detection, identification, diagnosis, prevention, and management of SWD and associated complications (Sandy-Hodgetts et al, 2020a). While considerable research has been conducted in the field of surgical site infection (SSI), a fundamental shift in mindset that encompasses a broader view of reducing all types of SWCs, including dehiscence, is needed.

Timely and sustained post-operative wound healing has a significant role to play in optimising a patient’s post-operative recovery and rehabilitation (Sandy-Hodgetts et al, 2015). In the therapeutic management of the surgical patient, an understanding of the factors that elevate a patient’s risk of SWD will guide the most appropriate prophylactic pre-, intra- and post-operative care (WUWHS, 2018). Use of risk assessment tools according to surgical domain is also needed to support clinicians to identify ‘at-risk’ patients, including patient-related comorbidities, and intra-operative and post-operative risk factors related to SWD (Sandy-Hodgetts et al, 2019).

To review the existing guidance from a UK perspective, a group of experts convened for an online meeting in April 2023 to develop this consensus document, focusing on the prevention, identification, and management of SWD. 

This consensus document aims to:

  • Review definitions of SWD and the current landscape of surgery and post-surgical wound complications in the UK
  • Discuss how international guidance applies to UK practice 
  • Provide guidance on risk assessment and prevention 
  • Provide guidance on identifying SWD and assess use of the WUWHS Sandy Grading System
  • Focus on management and follow-up.

The overall aim is to examine the current landscape of surgery and post-surgical wound complications in the UK, with the goal of improving patient experiences and outcomes. 

Rhidian Morgan-Jones, Chair

Disclaimer: This document has been developed by Wounds UK and supported by Smith+Nephew.

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