Care for a reopened surgical wound in Arnold.

About reopened surgical wounds

Dehiscence is the term clinicians use when a surgical incision separates after it has been closed. The closure might have been stitches, staples, adhesive strips or skin glue. In a partial dehiscence, only the skin and the fatty layer just beneath it come apart, and the gap may be no longer than a fingertip. In a deeper one, the strong layer that holds the muscles together also gives way, which is a more serious problem and belongs with the surgeon right away. Most reopened incisions show up while the person is still in the early weeks of recovery, often around the time staples or stitches come out. Some open all at once. Others begin as a small damp spot along the line that slowly widens.

How the care plan is built

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.

Local context: Arnold

From Arnold, the surgeon’s office may be a long drive away, and a car ride is hard on a reopened incision. A seat belt sits across a belly or chest incision, and getting in and out of a vehicle takes the bending and twisting that surgeons often restrict. Bringing wound visits to the home cuts down on those trips. Because family caregivers here often commute and are gone during the day, we ask when someone can be present, and the treating clinician can plan dressing changes or home health nursing around the hours the patient would otherwise be alone.

Cross the Meramec River on Interstate 55 and the first city you reach is Arnold, the largest in Jefferson County. Subdivisions spread over the hills on both sides of the interstate, and Jeffco Boulevard carries much of the local traffic. For daily errands Arnold is self-contained, but a good deal of specialty care sits north of the river in St. Louis County. For someone with a wound that needs frequent attention, or for a caregiver who works, that bridge crossing adds up. Care that comes to the home or facility takes the trip out of the week.

When care happens at home

Most of the work on a dehisced wound happens between clinician visits. Someone has to change the dressing on the schedule the clinician ordered, and after abdominal or back surgery the patient often cannot see or reach the incision alone. That job usually falls to a spouse, an adult child or a visiting nurse. The clinician can show a caregiver what the orders involve and what a normal dressing looks like when it comes off. It helps to keep a simple log with the date, how wet the old dressing was and anything that looked different. Bring the log and your questions to the next visit.

Care in skilled nursing and assisted living

In a facility, wound orders live in the resident’s chart and go through the attending physician. A partner clinician who visits for a reopened incision documents the assessment, recommends or writes orders according to the facility’s process, and leaves clear instructions for the nurses who will do the dressing changes. Gateway handles the scheduling with the nursing leadership, requests surgical records the facility may not have received, and coordinates with the surgeon’s office about follow-up appointments. That last piece matters, because a trip out to the surgeon means transportation, an escort and a dressing that will hold up through the ride.

Signs to tell the clinician about

Whoever looks after the wound, whether family at home or nurses in a facility, should know which findings cannot wait for the next scheduled visit. Report to the treating clinician:

• Wound edges that were pink turning dark, gray or black
• A pocket or tunnel that is new or deeper
• A sudden increase in drainage or a strong odor
• Fever, chills or a racing heartbeat
• A wound therapy pump that alarms repeatedly or loses its seal

Call 911 when an abdominal wound separates widely or its contents push through, when bleeding will not stop, or when there is chest pain, labored breathing, collapse or sudden confusion.

How primary care fits in

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 Arnold →

How to get started in Arnold

For a resident of a nursing home, assisted living or memory care community in Arnold, a request for care for a reopened surgical wound can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

Before you call about care in Arnold, write down the patient’s address and the nearest cross street, the best phone number, the insurance cards on hand and the name of the doctor who knows them best. If a home health agency is already involved, tell us that as well. Because Arnold sits at the top of Jefferson County, visits here can be planned together with nearby Imperial, Oakville, Mehlville and Fenton. Addresses farther into Jefferson County are welcome too, and availability is confirmed case by case.

• County: Jefferson County, Missouri
• ZIP codes: 63010
• Nearby hospitals: Mercy Hospital South; Mercy Hospital Jefferson in Festus; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
• Nearby communities: Jefferson County, Oakville, Imperial, Fenton, Mehlville
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Arnold

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

• Diabetic foot ulcers
• Venous leg ulcers
• Pressure injuries and bed sores
• Arterial and mixed wounds
• Non-healing wounds
• Post-surgical wounds
• Surgical site infections
• Skin tears and traumatic wounds
• Wounds with lymphedema
• Skin graft aftercare
• Wound VAC (NPWT) follow-up
• Care for a reopened surgical wound in Jefferson County
• Care for a reopened surgical wound in Oakville
• Care for a reopened surgical wound in Mehlville

Common questions