During a physical examination, the nurses noted that there is a separation of the layers of a surgical wound. They will record it in the record sheet as:

Appeared in: DSSSB 6 September 2024

Explanation

Dehiscence is the specific medical term for the partial or complete separation of the layers of a surgical incision or wound.
The description in the question, 'separation of the layers of a surgical wound,' directly matches the definition of dehiscence.
This complication can range from a superficial separation of the skin layer to a complete separation of all tissue layers, including fascia.
It often occurs 5 to 10 days postoperatively, before the wound has gained significant tensile strength.

Option A: Herniation is the protrusion of an organ or tissue through a weakness in the surrounding muscle or connective tissue, not the separation of a surgical incision itself.
Option C: Prolapse refers to the downward displacement or 'slipping' of an entire organ from its normal anatomical position, such as a uterine or rectal prolapse.
Option D: Evisceration is a more severe condition than dehiscence. While it involves wound separation, its defining feature is the protrusion of internal organs (viscera) through the incision.

Clinical Relevance

Nursing practice connection: Knowing Postoperative wound complications helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Recognizing the difference between dehiscence and evisceration is a critical nursing skill, as evisceration is a surgical emergency requiring immediate intervention to prevent tissue necrosis and infection.
Risk factors for dehiscence include obesity, malnutrition, infection, coughing, and diabetes. Nurses should assess for these risks in postoperative patients.
What if the nurse observed a gush of serosanguineous (pinkish) fluid from the wound? This is often a warning sign of impending dehiscence and evisceration and requires immediate notification of the surgeon and reinforcement of the dressing.

How to Approach the Question

First, identify the key phrase in the question: 'separation of the layers of a surgical wound'.
Next, recall the definitions of the postoperative complications listed in the options.
Match the key phrase to the most accurate definition. 'Separation of layers' is the textbook definition of dehiscence.
Differentiate this from the other terms. Evisceration involves organ protrusion, herniation is protrusion through a weak wall, and prolapse is the slipping of an organ. Since only separation is mentioned, dehiscence is the best fit.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 126-128

E6 Gynecology Williams p. 65-89

Practise the full DSSSB 6 September 2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.