Management of Wound Dehiscence Following Suture Removal

Immediate Assessment

The American College of Surgeons recommends performing a focused examination looking for signs of infection, such as erythema, warmth, purulent drainage, increased pain, or systemic signs, when dehiscence follows suture removal 1
The assessment should also include wound characteristics, such as depth of separation, ability to approximate edges, and presence of tissue necrosis 2
The timing context of dehiscence is also important, as dehiscence occurring within days of suture removal suggests premature removal or inadequate wound tensile strength 3

The World Health Organization recommends using interrupted sutures with 5-0 or 6-0 monofilament non-absorbable sutures for facial wounds 2
The American College of Surgeons suggests considering layered closure starting with deeper layers if the dehiscence extends beyond superficial tissue 2
For infected or contaminated dehiscence, the Centers for Disease Control and Prevention recommend removing any remaining retained suture material immediately, as this significantly increases infection risk 1
Obtaining a Gram stain and culture of any purulent drainage is also recommended 1
Initiating antibiotic therapy active against Staphylococcus aureus, including MRSA coverage if risk factors are present, is also suggested 1

The use of absorbable subcuticular continuous sutures reduces superficial wound dehiscence by 92% compared to non-absorbable interrupted sutures 3
These absorbable sutures retain 50-75% of original tensile strength after 1 week, providing continued wound support after the critical early healing period 3
Non-absorbable sutures should be removed at 5-7 days for facial wounds and 7-9 days for other locations to minimize scarring while ensuring adequate healing 2, 1

The use of triclosan-coated sutures significantly reduces surgical site infection prevalence compared to non-coated sutures 1

Keeping wounds clean and dry for the first 24-48 hours is recommended 2
Using chlorhexidine 0.12% rinses twice daily for lip lacerations can reduce bacterial load 2
Monitoring closely for infection signs, such as increasing pain, redness, swelling, or purulent discharge, is also important 2

The American College of Surgeons recommends avoiding the use of adhesive steri-strips routinely after resuturing, as evidence shows no improvement in cosmetic outcomes or scar width when added to buried dermal sutures 2
Leaving any superficial or exposed suture material can significantly increase infection risk 1
Removing sutures prematurely can also lead to inadequate wound tensile strength and increase the risk of dehiscence 3, 2

The presence of systemic signs such as fever, leucocitosis, and tachycardia should be evaluated when assessing wound dehiscence, according to the American College of Surgeons 4

When re-suturing a dehiscence without infection, a continuous subcuticular suture technique with absorbable monofilament material (poliglecaprone 4-0 or polyglactin 4-0) should be used, and closure without tension should be achieved by making periosteal incisions when necessary, as recommended by the American Academy of Periodontology 5