Care for a reopened surgical wound in Downtown St. Louis.

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.

How the care plan is built

Measurements matter more than impressions with an open surgical wound, so the treating clinician records the same points at each visit and compares them over time:

• Length, width and depth of the opening
• The kind of tissue in the base, and how much of it looks healthy
• Any tunnel or pocket under the edges, and which direction it runs
• How much drainage the dressing held, and its color
• The condition of the surrounding skin

When the numbers shrink from visit to visit, the plan is working. When they hold still or grow, the clinician looks for a reason, such as infection, strain on the area or a dressing that no longer suits the wound, and adjusts the orders.

Local context: Downtown St. Louis

People in Downtown St. Louis often live a short distance from the hospital where they had surgery, yet close is not the same as easy. Getting to a large medical center means a ride, a parking garage, long corridors and a wait in a chair, all with an open incision under your clothes. Gateway arranges wound visits in the apartment or house instead, and coordinates with the surgeon’s office so that in-person surgical appointments are saved for when the surgeon needs to examine the wound. If your building has an unreliable elevator or a locked entrance, mention it when you call.

Downtown St. Louis is the central business district beside the riverfront, stretching west from the Gateway Arch through Downtown West. Many of its former warehouses and office buildings along Washington Avenue and the nearby streets are now lofts and apartments, and people of every age live among the stadiums, hotels and courthouses. Living downtown often means living without a car, in a building with elevators, secured doors and a front desk. For a resident with a wound or a chronic illness, care that comes up to the apartment is far simpler than arranging a ride out.

Care at home

Supplies for an open surgical wound add up quickly: packing or filler material, cover dressings, tape or wraps, wound cleanser and gloves. Once the treating clinician writes the orders, Gateway coordinates the supply request so the ordered items can be sent to the house, and updates it when the orders change. Running out over a weekend is a common and avoidable problem, so tell us when you are down to a few days of dressings. The house itself matters too. A bed that is hard to get out of, a low chair or a laundry basket that needs carrying can all strain a fresh abdominal or hip incision. Mention those obstacles during the visit.

For residents of nursing and senior living communities

With memory care residents, the hardest part of a reopened incision is often keeping the dressing on. A resident who does not remember the surgery may pick at the tape, pull out packing or tug on device tubing, and may not be able to say that the area hurts. The treating clinician takes that into account when choosing dressings and how they are secured. Staff watch for nonverbal signs such as guarding the area, restlessness or resisting being moved. Gateway coordinates visits for the time of day when the resident is usually calmest, and keeps the family and the attending physician informed of what the clinician finds.

Changes to report

A reopened incision should look a little better, or at least no worse, each time the dressing comes off. Tell the treating clinician or the surgeon’s office promptly if you notice:

• The gap growing longer, wider or deeper
• Thick, cloudy or foul-smelling drainage
• Redness that is spreading outward from the edges
• A fever, chills or a new sense of being ill
• Stitches, staples or mesh showing that were not visible before

Call 911 if an abdominal incision bursts open, if anything bulges out through the wound, if bleeding will not stop, or if you have chest pain or trouble breathing.

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 Downtown St. Louis →

How to get started in Downtown St. Louis

For a resident of a nursing home, assisted living or memory care community in Downtown St. Louis, 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.

Three things make a request for care in Downtown St. Louis go smoothly. First, the full address with unit number and ZIP code, whether 63101, 63102 or 63103. Second, access details: call box name, door code, front desk hours, guest parking or the nearest garage. Third, a phone that will be answered when the clinician arrives. Ball games, concerts and street closures can affect timing, so we plan around them where we can. Gateway also arranges care in the Central West End, North St. Louis, South St. Louis and across St. Louis City.

• County: City of St. Louis, Missouri (an independent city)
• ZIP codes: 63101, 63102, 63103
• Nearby hospitals: SSM Health Saint Louis University Hospital; Barnes-Jewish Hospital (not affiliated with Gateway)
• Nearby communities: St. Louis City, Central West End, North St. Louis, South St. Louis
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

Read the full guide to reopened surgical wounds, or see everything Gateway arranges on the mobile wound care in Downtown St. Louis 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 the City of St. Louis
• Care for a reopened surgical wound in the Central West End
• Care for a reopened surgical wound in North St. Louis
• Care for a reopened surgical wound in South St. Louis

Common questions