Wound Dehiscence: Safety, Recovery & Revision Guide
An incision can come apart, and the question a patient asks first is not the one most writing answers. Nobody at home needs a catalogue of everything that can go wrong after an operation. What is needed is a way to place the thing in front of you: is this what healing looks like, is this the wound opening, and how quickly does anyone need to know. This site sorts every finding at an incision into three groups. Some mean emergency care now, and they are named at the top of this page and of every page on the site. Some mean the surgical team should be telephoned today rather than at the next review. The rest are ordinary healing, and knowing which is which is what stops a patient either panicking at a crust or waiting three days on a wound that has parted.
Chongqing West District Hospital, a tertiary general hospital in Jiulongpo District, Chongqing. This site is patient education; it cannot assess you and it is not an emergency channel. If any finding in the emergency list is present now, get emergency care now rather than reading further.
An incision that has parted with bowel or deeper tissue visible through the gap is an emergency, and so is bleeding that does not stop with firm pressure. So is fever with chills or shivering, redness spreading with heat and hardness around the wound, difficulty breathing or chest pain, and feeling faint or unable to keep fluids down. Cover the wound with a clean dressing and go to the nearest emergency department now, and take your discharge summary with you. An incision that has parted but looks shallow, discharge that is increasing rather than drying, pus or a bad smell, or pain far worse than the operation would explain is contact with the surgical team the same day rather than the emergency department. Do not push the edges together, do not put anything into the wound, and do not wait to see whether it settles.
What ordinary healing looks like, and what is not ordinary
The useful question at an incision is not how bad it looks but whether the skin is still closed and which way the finding is going. Ordinary healing is at its worst early and then eases. Redness and warmth stay along the line of the incision in the first week. A small amount of clear or blood-tinged fluid appears on the dressing and then dries. Swelling is worse in the evening and after activity and then settles. There is a pulling or tight feeling when you move, cough or stand up. Itching and a raised pink scar appear as healing advances, and small surface crusts sit over intact skin. None of that needs a telephone call. What is not ordinary is a change of direction or a break in the skin. Redness that spreads away from the incision, or that arrives with heat and hardness, is a different finding from redness confined to the line. Discharge that increases instead of drying, that turns cloudy, yellow or foul-smelling, is a different finding from a little clear fluid. Pain that climbs, or that is far worse than the operation would explain, is a different finding from pain that is easing. A soft bulge under the scar that appears when you cough or stand usually means something is collecting beneath a closed wound. And a gap between the edges is the finding this site exists for. Read direction and depth together: a wound that is easing and still closed is ordinary, and a wound that is changing or has opened is not. If you cannot tell which you are looking at, that is a reason to telephone the team rather than to keep watching.
What to do when something at the incision worries you
Decide which group you are in rather than whether the finding is serious, because that is the smaller question and the one the groups were built for. Emergency care now: the incision has parted and bowel or deeper tissue is visible in the gap, bleeding does not stop with firm pressure, there is fever with chills or shivering, redness is spreading with heat and hardness, breathing is difficult or there is chest pain, or the person feels faint or cannot keep fluids down. Cover the wound with a clean dressing, take the discharge summary, and go to the nearest emergency department. Contact the surgical team today, and cover the wound in the meantime: the incision has parted but the gap looks shallow, discharge is increasing rather than drying, there is pus or a bad smell, or pain is far worse than expected. Ordinary healing, to raise at the next review: a little clear or blood-tinged fluid, small crusts over intact skin, mild redness along the line, itching, and a tight pulling feeling when you move. Before you call, note four things, because they are what the person answering will ask for. What the wound looks like now, and the hour it changed. Whether the gap or the discharge is increasing. Which operation you had, and on which date. And the one thing you are most worried about, said first rather than last. Lay flat rather than carrying on, keep the dressing clean and dry, and put nothing into the wound. If you cannot place yourself in a group, take the higher one; being seen and told that nothing is wrong costs an evening, and the other error costs days.
How an open wound is assessed
Once you are seen, the assessment follows a settled order. Each part of it answers a question that changes what happens next rather than a question that is merely recorded.
Depth first, because it decides the urgency
The wound is looked at rather than described, and the first question is how deep the separation goes. Skin that has parted over intact tissue underneath is a shallow separation, commonly managed with dressings and review. A separation that exposes the layer beneath the skin, or deeper, is a different problem, and if bowel or the contents of the abdomen are visible it is an emergency rather than a clinic appointment. The size of the gap on the surface says less about this than what can be seen inside it.
The state of the tissue at the edges
The edges are examined for colour, warmth and how well they bleed, because tissue that is healthy holds a repair and tissue that is not does not. Skin that is dusky, grey or cold, or that does not bleed when it is touched, changes the plan towards letting the wound settle and heal from its base rather than closing it. Swelling and tension around the wound are read in the same way, since a closure attempted under tension tends to come apart again.
Infection, looked for rather than assumed
Redness, heat, hardness, pus, a bad smell and the amount and colour of the discharge are recorded together, with the temperature and the pulse and how unwell the person looks. A wound that has separated is more likely to be infected than one that has not, and an infection is dealt with before any decision about closing the wound, because closing over an infection tends to fail and to trap what should drain.
What is collecting beneath the wound
A soft bulge that appears when the patient coughs or stands, or a wound that keeps weeping after the edges have met, suggests fluid or blood collecting under the incision. That is felt as well as seen, and it is one of the reasons a wound is examined by hand rather than from a photograph. Where a collection is suspected, the decision is whether it needs to be released before anything else is done.
The patient, not only the wound
Weight, nutrition, blood sugar control, smoking, steroid or other medication, and how much the patient has been doing since discharge are all part of the assessment, because they are the reasons a wound fails to hold. Circulation in the area, and the presence of a cough or constipation that pushes pressure into the incision, are asked about directly. These are also the factors a patient can change, so they are discussed rather than noted.
The plan, the interval and who to call
The assessment ends in a decision and a timescale: what is being done to the wound now, how the dressing is to be managed at home, what is being watched for, when it will be reviewed, and who to contact in between. Being told that the wound is shallow and will be managed with dressings is a complete answer, provided it comes with that interval and that contact. An assessment that ends with reassurance and no timescale leaves the patient judging the next change alone.
What a revision can and cannot put right, and when it is planned
When an incision separates, the first question patients ask is when it will be closed again, and the honest answer is usually later than they expect. A wound that has opened is not closed straight away while swelling, infection or poor tissue are still present, because a closure attempted then tends to fail and to trap what should drain. Most separations are managed by letting the wound settle, keeping it clean and dressed, and allowing it to heal from its base, which takes weeks rather than days and leaves a broader scar than the original line. Where the separation is small and shallow and the tissue is healthy, the surgeon may bring the edges together, sometimes with a strip or a stitch; where it is not, the decision is to let it heal and to revise afterwards. Definitive revision is usually planned once the wound has been closed for several months and the scar has matured, because operating on a scar that is still changing produces a result nobody can judge. That interval is measured in months rather than weeks, and it is a range rather than a date. Two things are worth saying plainly. Healing after a separation takes longer than the original recovery, and the appearance is judged at months rather than at the first dressing change. And a revision is another operation, with its own recovery and its own risks; it improves a scar rather than removing it, and it is planned with the surgeon who knows how the wound behaved rather than booked at the first sign of trouble.
How to reach care, and what this site cannot do
This site publishes no emergency telephone number, no room number and no opening hours of its own, because a number printed on a website can be wrong at the moment it matters most. In an emergency, do not use this site to ask for help. Emergency services or the nearest emergency department is the route for difficulty breathing, chest pain, bleeding from the wound that does not stop with firm pressure, fever with chills or shivering, redness spreading with heat and hardness, a separation deep enough that bowel or the tissue beneath the skin is visible, and feeling faint or unable to keep fluids down. Say what operation you had and when, and bring the discharge summary with you; a description over the telephone is not an assessment. The surgical team is the route for a separation that looks shallow, discharge that is increasing rather than drying, pus or a bad smell, and pain far worse than the operation would explain. Those are handled the same day, and the team that performed the operation holds the record that makes the assessment faster. The hospital main line is the route when the team cannot be reached and the finding is not in the emergency list. Two things override anything written here. The first is the aftercare instructions your own team gave you, because they were written for your operation. The second is your own judgement that something is wrong. With any finding on this page, being seen early and told that nothing is wrong is a good outcome, and it costs an inconvenient evening rather than a lost week.
Wound dehiscence: normal healing, or should you seek care now
The left column is what ordinary healing does. The right column is what needs care, and how soon. Read them against each other, because the finding that matters at an incision is usually a change of direction rather than a change of severity.
The ten guides
Each guide answers one question a patient or a family member actually asks when an incision looks wrong. The first three cover what ordinary healing is, what a separation is, and how depth changes the decision, so start there if you are worried now.
Is This Normal Healing, or Has the Wound Opened?
How to read an incision at home: what ordinary healing does, and the findings that mean the edges have parted rather than settled.
Read the guide →What Normal Wound Healing Looks Like, Day by Day
The expected appearance, feeling and discharge at each stage of the first six weeks, so a change stands out against a baseline you know.
Read the guide →Superficial or Full-Thickness Separation: Why the Depth Changes Everything
Skin that has parted over intact tissue is managed with dressings; a separation that reaches deeper is assessed the same day. Depth is the difference.
Read the guide →Reading Wound Discharge: What Each Colour and Amount Means
Clear, blood-tinged, yellow and foul are four different messages from an incision, and only some of them mean you should telephone the team today.
Read the guide →Red Flags After Surgery: When to Seek Care the Same Day
The findings at an incision that must not wait for a scheduled appointment, each with the specific action and the timeframe that belongs to it.
Read the guide →The First Hour After a Wound Opens: What to Do Before You Are Seen
Cover it, do not push it back together, note the time, stop activity and contact the team: the steps in the order they matter most.
Read the guide →If the wound looks wrong, make the call
Contact the surgical team. Say what operation you had and when, describe what the incision looks like now and which way it is changing, and we will say whether it is a telephone call, a same-day assessment, or emergency care now.
Frequently asked questions
How can I tell whether my incision is healing or has come apart?
Look at whether the skin is still closed and which way the finding is going. A wound that is easing and holding together is ordinary: redness along the line, a little clear fluid, swelling that settles, itching and small crusts over intact skin. A gap between the edges, discharge that increases rather than dries, or redness spreading with heat and hardness means the wound has changed.
Does a small gap in the incision matter more than a large bruise?
Usually yes. Bruising and swelling are expected after an operation and say little about whether the wound is closed. A gap of a few millimetres with tissue visible inside it is the finding that decides what happens next, and it is easy to miss because it can be small and quiet at the beginning. The size of the gap on the surface matters less than what can be seen inside it.
Is an incision that has opened always an emergency?
No, and treating every separation as one makes patients stop reading. A separation that shows bowel or deeper tissue through the gap, bleeding that does not stop with firm pressure, fever with chills or shivering, or redness spreading with heat and hardness is emergency care now. A shallow separation, discharge that is increasing, pus or a bad smell, or pain far worse than expected is contact with the surgical team the same day.
Should I push the edges of the wound back together?
No. Pressing the edges together does not close the wound, and it pushes surface bacteria into the tissue underneath. Cover the wound with a clean dressing, note the hour it changed, stop any activity that is pulling on the incision, and contact the team. An improvised closure with tape or an adhesive strip is not a repair, and it hides the wound from the person who has to assess it.
How long does an incision take to heal after it has opened?
Longer than the original recovery, and usually measured in weeks rather than days, because a wound that has opened is often left to heal from its base rather than closed straight away. The time varies with the depth of the separation, the state of the tissue and the factors that caused it. Any figure quoted to you is an honest range rather than a date.
When can a revision of the scar be planned?
Usually once the wound has been closed for several months and the scar has matured, because operating on a scar that is still changing produces a result nobody can judge. The interval is measured in months rather than weeks. A revision is another operation with its own recovery and its own risks: it improves a scar rather than removing it.
Part of When Something Goes Wrong — 10 sites on this topic