Abstract
Suture dehiscence refers to the partial or complete reopening of a surgical wound, constituting one of the most feared complications across various surgical specialties. This occurrence can result in the exposure of internal organs or tissues, secondary infections, prolonged hospitalization and increased healthcare costs. Major risk factors include surgical site infections, poor suturing technique, inadequate use of closure materials, comorbidities (e.g., diabetes, hypertension and obesity) and systemic conditions that impair healing, such as immunosuppression or malnutrition. Preventive measures and reducing dehiscence rates involve appropriate antibiotic prophylaxis, careful surgical techniques, standardized aseptic protocols, glycemic control and nutritional support. Additionally, continuous training of multidisciplinary teams-including surgeons, nurses and nutritionists-plays a crucial role in risk reduction by promoting evidence-based and updated clinical practices. It is concluded that the adoption of strict infection control protocols, the correct selection of suture materials and techniques, attention to comorbidities and postoperative clinical surveillance constitute the foundation for minimizing dehiscence incidence and improving patient outcomes.
Keywords: Suture dehiscence; Risk factors; Prevention; Surgical infection; Wound healing
Introduction
Surgery is a field where the risk
of complications is always present, regardless of the specialty or type of
procedure. In this context, suture dehiscence emerges as a particularly
relevant complication, which may occur to varying degrees: from a partial
opening of some stitches to complete failure of the suture with exposure of
deep tissues1. This complication not
only prolongs recovery time and hospital stay but also burdens the healthcare
system and, in extreme cases, can lead to life-threatening conditions2.
Several risk factors contribute to the onset of suture dehiscence, particularly systemic patient conditions (e.g., diabetes mellitus, hypertension, obesity and immunosuppression), poor infection control, malnutrition, smoking and the use of medications such as corticosteroids3. These elements can impair tissue healing by compromising local microcirculation or reducing the body's defense capacity.
In addition to individual clinical aspects, technical factors related to the surgical procedure significantly influence dehiscence development. Excessive tissue tension, inappropriate suture material selection and poor suturing technique may cause weakness along the incision line4. Likewise, contamination of the surgical site during the procedure or lack of proper antibiotic prophylaxis greatly increases infection risk, which, in turn, promotes suture failure5.
From a preventive perspective, careful management of risk factors and the adoption of best practice strategies are essential. Evidence-based antibiotic prophylaxis protocols, adequate preoperative preparation and the use of surgical suturing techniques that respect tissue physiology are fundamental measures to reduce dehiscence incidence6. Furthermore, a multidisciplinary approach involving surgeons, nurses, nutritionists and other healthcare professionals ensures comprehensive patient care and broadens the capacity for identifying and addressing predisposing factors.
Objectives
This review aims to identify and analyze the main risk factors
associated with suture dehiscence, as well as to discuss preventive strategies
reported in recent literature.
Materials and
Methods
A literature
review was conducted based on articles published in the PubMed, ScienceDirect
and SciELO databases to support this study.
Discussion
Clinical factors such as diabetes,
obesity and hypertension are widely described as impairing tissue healing.
Diabetes, for example, alters glucose metabolism and causes microvascular
changes that reduce oxygen and nutrient delivery to tissues, resulting in
delayed healing and increased infection risk7.
Obesity, in addition to making surgical handling more difficult, is associated
with greater tissue tension and lower vascularization of adipose areas,
compromising suture integration8.
Malnutrition and deficiencies in vitamins and minerals also play a significant
role in the healing process. The lack of essential amino acids can compromise
collagen synthesis, a crucial structure for tissue repair9. Chronic use of corticosteroids,
immunosuppressants or chemotherapy drugs negatively affects the inflammatory
response and collagen deposition, further increasing dehiscence risk10. In the intraoperative setting, the suturing
technique used is critical for incision integrity11.
Improper tension on wound edges, insufficient suture depth or the use of
unsuitable suture material may lead to weak areas. Studies suggest that
continuous suturing methods in high-tension regions are more prone to failure
compared to interrupted sutures, which provide better force distribution12. Suture selection should consider factors
such as elasticity, tensile strength, biocompatibility and absorption rate13. In specific procedures, the use of mesh
reinforcement or surgical adhesives may reduce tension on the suture line,
providing safer closure14.
Infection is one of the main determinants of dehiscence. Bacteria present in the wound release toxins and enzymes that damage connective tissue, compromising sutures11. In such cases, antibiotic prophylaxis protocols must be strictly followed, based on the likely bacterial flora of the surgical site and procedure duration5. Maintaining aseptic technique and proper postoperative nursing care is essential to minimize contamination risk12. Preventing suture dehiscence requires considering all aspects of surgery, from preoperative preparation to patient rehabilitation. This calls for a multidisciplinary approach, where surgeons, nurses, nutritionists and other professionals work together2. Adequate nutritional support, metabolic control (especially in diabetic patients) and attention to psychosocial factors (such as smoking and physical inactivity) are key elements for a positive prognosis15. Strategies such as reducing surgical time, using appropriate instruments and standardizing wound closure protocols (including suture type, suturing technique and reinforcement measures) can significantly lower dehiscence rates6. After discharge, close outpatient monitoring and vigilance for signs of infection or tissue necrosis are critical for early intervention in the event of partial wound failure8.
Conclusion
Suture dehiscence is a
multifactorial complication, involving both patient-related aspects (clinical,
nutritional and immunological conditions) and surgical factors (suturing
technique, infection control and procedure duration). Given this complexity,
prevention requires a comprehensive analysis of all potential risks and
integrated action by various healthcare professionals. Key strategies include
proper management of comorbidities (especially glycemic control in diabetics),
careful antibiotic prophylaxis, appropriate selection of suture materials and
techniques and strict aseptic protocols throughout the surgical procedure.
Supportive measures, such as nutritional monitoring and health education for
patients and care teams, further contribute to reducing postoperative
complications13. Although recent
literature shows progress in understanding the mechanisms involved and
developing increasingly sophisticated suture materials, the challenge of
significantly reducing dehiscence rates remains. Evidence-based practice,
coupled with institutional protocol adoption and continuous team training,
appears to be a promising path toward improving surgical outcomes and
minimizing the negative impact of this complication. In summary, suture
dehiscence can be drastically reduced through effective preventive measures
targeting both intrinsic patient factors and the technical and logistical
aspects of the surgical procedure. Future research exploring innovative
approaches and multicenter studies validating prevention protocols may
significantly contribute to the advancement of surgical practices and the
overall improvement of patient safety.
References
1.
Silva AR,
et al. Fatores de risco para deiscência de sutura: uma revisão sistemática. Revista Brasileira de Cirurgia 2021;35(2):125-140.
2.
Ferreira JO,
et al. Estratégias para redução de complicações pós-cirúrgicas. Revista de Saúde e Medicina, 2023;14(2):200-210.
3.
Moreira EC,
et al. Aspectos clínicos da deiscência de sutura. Revista
de Cirurgia Contemporânea 2021;7(2):66-77.
4.
Smith K, et al. Advances in
wound closure techniques. Surgical Innovations 2019;47:34-48.
5.
Brasil. Ministério da Saúde. Diretrizes para prevenção de infecção
hospitalar. Brasília: Ministério da Saúde 2020.
6.
Oliveira MT, Souza CR.
Complicações cirúrgicas: análise de fatores predisponentes. J de Medicina
Cirúrgica 2020;28(3):88-97.
7.
Johnson R. Surgical site
infections and wound dehiscence: risk assessment. Int J Surg 2021;56:98-105.
8.
Ribeiro PC,
Santos LA. Manejo pós-operatório e suas implicações na cicatrização. Revista de Enfermagem Cirúrgica 2022;12(1):22-33.
9. Costa RM, Almeida
FO. Sutura e cicatrização: uma abordagem atualizada. São Paulo: Editora Médica
2018.
10. Gomes AR. Fatores determinantes
na cicatrização de feridas cirúrgicas. Anais da Sociedade Brasileira de
Cirurgia 2020;39(1):55-67
11.
Smith J, et al. Surgical wound
dehiscence: prevention strategies. J Surg Res 2019;250:45-52.
12.
Santos BF,
et al. Estratégias preventivas para infecção cirúrgica. Brazilian Surg J 2022;50:78-90.
13.
Martins DL,
et al. Uso de curativos modernos na prevenção de deiscência cirúrgica. Revista
Brasileira de Enfermagem 2020;73(4):789-795.
14.
Brown L, et al. Postoperative
wound healing complications. Clin Surg 2023;65:155-170.
15.
Pereira VH,
et al. Influência da nutrição na cicatrização de feridas. Revista Nutrição e Saúde 2021;16(3):120-135.