de-hisc--ence — Partial or total separation of previously approximated wound edges (failure of wound closure integrity)
Dehiscence is the partial or total separation of a surgically closed wound after operative closure, occurring most commonly 5-8 days postoperatively when healing is still in the early proliferative phase and tensile strength is at its lowest; it is classified by depth — superficial dehiscence involves skin layers only with the fascial layer (rectus sheath) remaining intact, while deep/fascial dehiscence involves all tissue layers and may progress to evisceration (extrusion of abdominal contents through the wound); the condition results from failure of the wound to achieve adequate tensile strength through collagen synthesis, and is precipitated by local factors (ischemia, hematoma, seroma, infection, poor closure technique) and systemic factors (diabetes, malnutrition, obesity, corticosteroid use, smoking, immunosuppression, advanced age); the classic clinical presentation is a sudden rush of serosanguineous fluid from an abdominal wound (“salmon-colored drainage”), accompanied by visible wound opening — a surgical emergency when the fascial layer is involved; the term dehiscence also applies beyond surgical wounds to traumatic wound repair breakdown and to obstetric wounds (cesarean, perineal), each with their own distinct ICD-10-CM code pathways.
latin
• de-: Latin prefix = “apart, away, down, undoing.”
• hisc-: Latin hiscere = “to open, to gape, to split apart” (inchoative form of hiare = “to yawn, to open wide”).
• -ence: Latin -entia = “state or condition of.”
• Literal: “The state of gaping open” or “the act of splitting apart.”
• The same root hiscere gives botany its term for seed pod splitting (dehiscent fruits) and anatomy its use for any structure that opens or ruptures along a natural seam. The word entered English medical usage in the 17th century, first in botanical contexts describing the opening of anthers and seed capsules, then adopted into surgical literature to describe wound failure — a vivid image of a wound “yawning open” like a ripened pod.
Classification Table
Type
Layers Involved
Clinical Significance
Superficial dehiscence
Skin/epidermis ± dermis only; fascia intact
Most common; manage with wound care, packing, secondary intention healing
Deep / fascial dehiscence
All layers through fascia
Surgical emergency; risk of evisceration; return to OR for repair
Evisceration
Full thickness + organ extrusion
True emergency; wet sterile dressing, NPO, emergent surgery
Assessment: Inspect wound daily; classic warning sign is serosanguineous “salmon-pink” drainage from abdominal wound; probe depth of opening; assess for fascial integrity (do NOT probe deeply in awake patient without preparation for possible evisceration); check for fever, leukocytosis (underlying SSI)
Symptoms: Visible wound opening, increased drainage, pain at incision site, serosanguineous discharge, fever if infected; sudden gush of fluid signals fascial dehiscenceManagement: Superficial → wound care, wet-to-dry dressings or NPWT, secondary intention; Deep/fascial → emergent OR, secondary closure (13160/49900); Evisceration → sterile saline-soaked gauze, NPO, emergent surgery
Timing: Peak risk days 5-8 postop; early (1-3 days) = technical failure; late (>10 days) = metabolic/infectious cause
One-Sentence SummaryDehiscence (Latin de- + hiscere, “to gape open”; T81.31XA/T81.31XD, coded with required 7th character for encounter type) is the partial or total separation of a surgically closed wound most commonly occurring days 5-8 postoperatively from ischemia, infection, or metabolic failure; managed by wound care and secondary intention for superficial cases or emergent surgical re-closure (13160/49900) for fascial/eviscerating dehiscence.
Crystal's MCW Coder Hub