What to know about post-surgical wounds

Any operation carries some chance of a wound problem, but certain people and procedures call for closer watching. Older adults, people with diabetes or vascular disease, people who smoke, and those who were underweight or carrying extra weight at the time of surgery are more likely to heal slowly. So are people who had emergency surgery, a long operation, bowel surgery, an amputation, or a second procedure through an old scar. People who take steroids or medicines that quiet the immune system, and people who have trouble moving, eating or keeping the area clean after discharge, belong on the same list. None of this means a problem will happen. It means the incision deserves regular, careful follow-up.

What the treating clinician looks at

A care plan for a surgical wound is built around what kind of wound it now is. The treating clinician sorts that out first, because each kind calls for something different:

  • A closed incision that only needs protection and monitoring
  • A closed incision with a drain, or with fluid collecting underneath
  • An incision that has partly separated
  • A wound the surgeon left open to heal from the base
  • A skin graft or flap site with its own instructions

The plan then sets the dressing type, how often it is changed and by whom, what the patient should avoid, and which findings would prompt a call to the surgeon.

Arranging this care in the Central West End

Living near major medical centers has a side effect: a patient in the Central West End may have a surgeon in one health system, a primary care office in another and a home health agency from a third. After an operation, each may give incision instructions. Gateway collects the operative note and discharge orders so the treating clinician works from the surgeon’s actual plan. City housing adds practical questions too, such as where dressing and drain supplies get delivered in a building without a front desk, and whether a bedroom up a narrow staircase is workable in the first weeks.

Housing in the Central West End stacks up as much as it spreads out. There are doorman towers along Lindell Boulevard and Kingshighway, brick walk-ups and converted mansions on the side streets, newer apartment buildings near the medical campus, and senior apartments, assisted living and skilled nursing within the neighborhood or a short distance away. Gateway arranges partner clinician visits in all of them. For secured buildings we ask ahead about the front desk, entry codes and visitor parking. For facilities we coordinate with the nursing team on timing and orders.

At home between visits

Supplies are where home recovery often goes wrong. The hospital sends you home with a few days of dressings, and then the gauze, tape or drain supplies run out over a weekend. Once the treating clinician writes an order, Gateway follows up with the supplier so the right items in the right sizes arrive before they are needed, and we check again when the order changes. If a negative pressure device is part of the plan, we help coordinate delivery, canister and dressing-kit resupply, and the question of who changes it.

Care in skilled nursing and assisted living

A resident with dementia may not remember having surgery, may pull at a dressing or pick at staples, and may not be able to say that an incision hurts. In memory care, the treating clinician relies on staff observations and plans for these realities, for example with a dressing that is harder to remove and clothing that covers the site. Staff are told which behaviors, such as new restlessness, guarding one side or refusing to walk, might signal a wound problem. Gateway keeps the family or legal representative updated and sends findings to the attending physician and the surgeon.

Signs to tell the clinician about

A healing incision should look a little better, or at least no worse, each day. Call the surgeon’s office or the treating clinician when the trend reverses:

  • A faint pink edge has become a wide red patch
  • A dry incision starts to leak
  • Soreness becomes throbbing or sharp
  • The area feels hot or tight
  • One calf becomes painful, swollen or warm

Do not wait on these to see what happens. Call 911 if deep tissue shows through an opened incision, if blood soaks dressings faster than you can replace them, or if you have chest pain, sudden breathlessness, fainting or new confusion.

Primary care and overall health

People leave the hospital with a changed medication list: new pain medicine, perhaps a blood thinner, an antibiotic course, stool softeners, and old prescriptions that were paused or adjusted. Some of these affect bleeding, bruising and how an incision heals, and it is easy to end up taking a duplicate or missing something that was meant to restart. A primary care clinician can go through the full list after discharge and sort out questions with the surgeon and the pharmacy. Arranging that review alongside wound visits means the wound care clinician knows what the patient is actually taking.

Primary care at home in the Central West End →

How to get started in the Central West End

People asking about post-surgical wound care in the Central West End 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.

Barnes-Jewish Hospital is in the neighborhood itself. SSM Health Saint Louis University Hospital is a short drive southeast on Grand Boulevard, and SSM Health St. Mary’s Hospital in Richmond Heights is just west of Forest Park. Gateway is independent of all three. When a patient from the Central West End is discharged, the case manager can fax a referral, or the family can call. We request the discharge records, confirm the home or facility address, and arrange follow-up with a treating clinician, so wound care continues after the hospital’s part ends.

More wound care in the Central West End

Read the full guide to post-surgical wounds, or see everything Gateway arranges on the mobile wound care in the Central West End page.

Common questions

Do I need a referral from my surgeon to arrange wound follow-up in the Central West End?

No. Patients, family members and caregivers can call Gateway directly, and surgical offices and discharge planners can refer as well. Once you call, we ask for permission to request the operative report and discharge instructions, because the treating clinician needs the surgeon’s orders before making decisions about the incision. Some health plans have their own referral rules, which we help you check.

The incision opened a little at one end. Is that an emergency?

A small, shallow gap with little drainage is usually not an emergency, but report it to the surgeon’s office or the treating clinician promptly so someone can look at it. Keep it covered the way your discharge instructions describe, and do not try to close it yourself. Call 911 if the wound opens widely, if you can see deep tissue, or if bleeding does not stop with firm pressure.

Why does my incision itch, feel numb or have a hard ridge under it?

Itching, patches of numbness and a firm ridge beneath the scar are common as an incision heals, because small nerves were cut and new tissue is forming. They usually ease gradually. Mention them at your next visit. Report them sooner if itching comes with a rash or blisters under the dressing, or if the firm area becomes larger, red, hot or painful.

Can a clinician visit a high-rise or secured building in the Central West End?

Yes. Tell us the building name, the unit number and how guests are admitted, whether through a front desk, a call box or a code. If the building needs advance notice or a name at the desk, we pass that to the visiting clinician. Mention any guest parking or the closest side street. Details like these are a normal part of planning a visit in the Central West End.

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.