Understanding reopened surgical wounds

Any operation can end with a reopened incision, but some people carry more risk than others. Wounds tend to knit more slowly in people living with diabetes, poor circulation, kidney disease or a weakened immune system, and in people who smoke. Extra body weight puts more pull on an abdominal closure and leaves a thicker fatty layer, which has a limited blood supply. Older adults with thin skin, people who were eating poorly before surgery, and people taking steroids long term are also more likely to have trouble. So are those whose operation was an emergency, ran long, or went through an old scar. None of this means dehiscence is certain. It tells the care team whom to watch closely.

What the treating clinician looks at

The care plan for a dehisced incision answers a few practical questions. What goes in and over the wound, and how often is it changed? Who changes it on the days between clinician visits? What activity limits did the surgeon set, and do they still apply? The treating clinician picks dressings to match the drainage and depth, and revises the choice as the wound fills in. For a deep or heavily draining wound, the clinician may order negative pressure wound therapy, which is a sealed dressing attached to a small pump. The plan also spells out which findings would send the patient back to the surgeon sooner than planned.

Arranging this care in Alton

Some people in Alton have surgery at an Illinois hospital and recover with Illinois home health. Others cross the river for an operation in St. Louis and then come home. Either way, a dehisced wound needs a treating clinician who can see patients on the Illinois side and who works with your plan. Illinois Medicaid and Missouri Medicaid are separate programs, and Medicare Advantage and commercial plans can differ by state. Before a visit is scheduled, Gateway confirms the treating provider and encourages you to check your benefits with the plan.

Alton rises from the Mississippi River in steep hills and bluffs, on the Illinois side upriver from St. Louis. The Clark Bridge connects it to Missouri, and the Great River Road follows the bluffs toward Grafton. It is an old city with brick streets, tall houses and neighborhoods that sit above or below one another. Those hills are part of what people love about Alton, and they are hard on anyone with a leg wound, poor balance or limited strength. Gateway arranges wound care and primary care in the home or facility, so the hills stay outside the door.

At home between visits

Many people come home from surgery with a home health agency already in place. When an incision opens, Gateway coordinates the wound care visits with that agency so the nurse and the treating clinician are following one set of orders, not two. If the clinician orders a wound therapy device, the agency nurse typically handles its scheduled dressing changes, and we help with the paperwork and delivery arrangements for the pump and its supplies. If no agency is involved and the wound needs skilled dressing changes several times a week, the treating clinician can decide whether a home health referral makes sense.

For residents of nursing and senior living communities

Assisted living communities differ in how much nursing care they can provide, and an open surgical wound can test those limits. Some have a nurse who can change a dressing daily. Others rely on a home health agency coming in. When a resident’s incision opens, Gateway asks the community what its staff can and cannot do, then arranges the treating clinician’s visits and any outside nursing around that answer. Aides who help with bathing and dressing need the basics from the clinician’s orders as well: how the dressing is protected during a shower, how to avoid pulling on the area during transfers, and whom to tell if it is soaked or loose.

Changes to report

Some changes come on gradually and some arrive in a moment. A pop or tearing feeling at the incision, followed by a gush of pink fluid, can mean deeper layers are separating, and the surgeon should hear about it right away. Also report:

  • A bulge under or beside the incision when you cough or stand
  • Drainage that soaks through a fresh dressing quickly
  • Red streaks, or warmth that has moved beyond the dressing border
  • Shaking chills or a raised temperature

Call 911 if the wound opens wide, if you can see tissue or organs coming through it, or if you are short of breath, faint or bleeding heavily.

Primary care and overall health

Closing an open surgical wound takes raw material. The body needs enough protein, calories and fluid to lay down new tissue, and appetite is often poor after an operation, especially in older adults. A primary care clinician can look at weight changes, check for problems such as trouble chewing or swallowing, nausea or low mood, and decide whether lab work or a nutrition referral is warranted. Wound drainage itself carries protein out of the body, which adds to the need. Ask before starting supplements, since the right choice depends on kidney function, diabetes and the medicines you take. Arranging wound care and primary care together lets both clinicians work from the same picture.

Primary care at home in Alton →

How to get started in Alton

People asking about care for a reopened surgical wound in Alton usually want to know what the first visit involves. Before it, Gateway collects the records the treating clinician asks for and confirms the time and place with you. During it, the clinician looks at the wound and the skin around it, measures it, asks about your health and medications and explains what they recommend. Afterward, the orders go to whoever does the daily care, supplies are requested and a follow-up is planned. Our guide to how mobile wound care visits work has more. To begin, call 314-325-0126. Whether a visit can be arranged is confirmed for your location.

When you call about care in Alton, mention right away that the address is in Illinois, and have the 62002 ZIP code, a phone number, the regular doctor and the insurance card on hand. Insurance plans and provider participation can differ on each side of the state line, so we check before scheduling. Availability is confirmed by location and care setting. Gateway also arranges care in Godfrey, the rest of the Riverbend, Edwardsville and elsewhere in Madison County.

Other conditions and nearby communities

Read the full guide to reopened surgical wounds, or see everything Gateway arranges on the mobile wound care in Alton page.

Common questions

Can someone come to a home in Alton to check a surgical incision that has opened?

In many cases, yes. Gateway arranges home visits with partner clinicians for people in Alton whose incision has separated, and the clinician examines the wound in the room where you are recovering. Availability is confirmed by location and care setting, so the first step is a call to 314-325-0126. If the incision has just opened and your surgeon does not know yet, call the surgical office as well.

Can I shower with an open surgical wound?

Ask the surgical team or the treating clinician before you do, because the answer depends on how deep the wound is, what dressing is on it and whether a device is attached. Some people are cleared to shower with the dressing protected or just before a scheduled change. Soaking in a bathtub, pool or hot tub is generally off limits until the surgical team says otherwise. Follow the written instructions you were given.

Is the area weaker after a dehisced wound finally closes?

Often, yes. A wound that fills in from the base leaves scar tissue that is less strong than uninjured skin, and it keeps maturing long after the surface has closed. After abdominal surgery, a weak spot in the deeper layer can later show up as a bulge near the scar, called an incisional hernia. Tell your surgeon or primary care clinician if you notice one, and ask the surgeon when lifting and exercise can resume.

My doctors are in Missouri but I live in Alton. Can care at home still be coordinated?

Yes. Give us the names of your Missouri doctors when you call. The partner clinician who visits you in Alton makes the clinical decisions for those visits, and we send notes to your other doctors with your permission so they stay informed. Tell us about upcoming appointments across the river so visits can be planned around them.

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.