Why is the wound on my abdomen not healing?

Most abdominal wounds are surgical. Dehiscence (the wound coming apart) typically happens 5 to 8 days after surgery, and increased abdominal pressure is one of its causes. A wound left open then heals from the inside out, often with packing.

Most abdominal wounds are surgical, and what goes wrong with them, and when, is well known.

Dehiscence is a partial or total separation of wound edges that had been closed, due to a failure of proper wound healing. It typically occurs 5 to 8 days after surgery, when healing is still in the early stages. Its causes include ischemia (poor blood supply), infection, increased abdominal pressure, diabetes, malnutrition, smoking, and obesity.

Increased abdominal pressure is the one on that list that belongs to this site in particular. Coughing, straining and lifting all load an abdominal closure in a way they do not load a wound elsewhere.

Here is what happens next, in plainer words: sometimes an incision breaks open, along the entire cut or just part of it, and your surgeon may decide not to close it again with sutures. The wound then heals from the inside to the outside, and a dressing helps absorb drainage and keeps the skin from closing before the wound underneath fills in.

That is why an abdominal wound may be packed. Gauze or packing tape is placed into the wound, carefully filling it and any spaces under the skin. As the wound heals, you should not need as much gauze or packing.

Some factors bear on this wound type directly. Obesity increases the risk of infection after surgery, and being overweight can put tension on stitches, which can make them break open. Smoking can delay healing after surgery and increases the risk for complications such as infection and wounds breaking open.

And the general list: infection, diabetes, poor blood flow, nerve damage, bone infection, immobility, a weak immune system, poor nutrition, excess alcohol use, smoking, and a foreign body in the wound.

The numbers: a wound that has not started to heal in 2 weeks, or has not completely healed in 6 weeks, is called non-healing, and surgical wounds are among the common types treated at a wound care center.

What to watch for

Contact your provider right away if you have a wound that has come open or the stitches or staples have come out too soon.

Contact your surgeon for more redness or pain, swelling or bleeding, a wound that is larger or deeper or looks dried out or dark, or drainage that increases or becomes thick, tan, green, or yellow, or smells bad.

For a surgical wound being managed open, the temperature to report is 100.5°F (38°C) or higher. For a closed surgical wound, it is above 100°F (37.7°C) for more than 4 hours. Use the one that matches your wound.

Spotting separating wound edges promptly matters for preventing worsening dehiscence, infection, and other complications — so a closure that is beginning to give is worth reporting.

Wound Wizard is general education and can’t assess your wound. Your surgeon is the right person to ask.

What we look at

  • Examining the wound and how far it has separated
  • Deciding whether to close it again or manage it open
  • Checking for infection and dead tissue
  • Teaching or reviewing the packing technique

Sources

  1. Wound Dehiscence — StatPearls, National Library of Medicine https://www.ncbi.nlm.nih.gov/books/NBK551712/
  2. Surgical wound care - open — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000040.htm
  3. How wounds heal — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000741.htm
  4. Wound care centers — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000739.htm