Care for a reopened surgical wound in Madison County, Illinois.

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

Part of assessing a dehisced wound is working out why it opened, because the cause changes the plan. If there are signs of infection, the treating clinician decides whether a culture or other tests are needed and raises treatment questions with the surgeon. If fluid had collected under the skin, the wound may drain heavily at first and then settle. If the opening exposes suture material, mesh or an implant, the surgeon needs to know, since that can change whether dressings alone are enough. The clinician also asks about the days before it opened: a coughing illness, a fall, new swelling, or a dressing that stayed wet. Each answer points to something the plan should address.

Local context: Madison County, Illinois

Some people in Madison County 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.

Madison County reaches from the Mississippi River at Alton and Granite City, over the bluffs to Edwardsville, Glen Carbon, Maryville and Collinsville, and east through farmland to Troy and Highland. Godfrey, Wood River and Bethalto fill in the north. That is a lot of ground, and the distance to a wound clinic or a doctor’s office varies widely from one town to the next. People who cannot travel easily, whether they live in a river-town bungalow or on a rural road, gain the most when care is arranged where they live.

At home between visits

Home visits for a reopened incision are planned around the surgeon’s instructions. Before the first one, Gateway requests the operative note and discharge paperwork, confirms who is currently writing wound orders, and schedules a partner clinician to come to the house. During the visit, the clinician examines and measures the wound, changes the dressing and writes or updates orders. A spot with good light where you can lie back comfortably is usually all that is needed, whether that is a bed, a recliner or a couch. Afterward we coordinate the next visit and share the clinician’s findings with the surgical office and others on the care team.

In a facility

Many people who develop a dehisced wound are already in a skilled nursing or rehabilitation center after a joint replacement, an abdominal operation or heart surgery. Therapy is the reason they are there, and therapy is also what loads the incision. When Gateway arranges a wound visit in a facility, the treating clinician shares findings with the nursing staff and the therapy team, so that transfers, walking practice and exercises fit whatever limits the surgeon and attending physician have set. Facility nurses carry out the ordered dressing changes, and they are usually the first to notice when the drainage or the wound edges change.

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

Two kinds of primary care problems hold back a healing incision: the ones that raise pressure and the ones that slow repair. A lingering cough, constipation from pain medicine, nausea with vomiting and trouble passing urine all push on an abdominal or chest closure, and each has causes a primary care clinician can sort out. Some medicines, including steroids and certain drugs that calm the immune system, can slow healing, but they are prescribed for good reasons. Never stop or change one on your own. Keep a full medicine list handy so the primary care clinician and the surgeon can decide together whether anything should be adjusted.

Primary care at home in Madison County →

Arranging care for a reopened surgical wound in Madison County

Setting up care for a reopened surgical wound for someone in Madison County usually goes in this order:

1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
2. Gateway talks with you about the wound, the address and the insurance.
3. We confirm availability for that location and gather records for the treating clinician.
4. The clinician visits, assesses the wound and writes the orders.
5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

A Madison County request goes more smoothly when the caller has the town and ZIP code, the type of residence, a phone number that will be answered, and the names of the doctors and any home health agency already involved. Gateway arranges care in Edwardsville, Glen Carbon, Collinsville, Granite City, Alton and Godfrey, among other communities. Because the county is large, availability differs between the river towns, the central communities and the eastern edge. We confirm it by address and care setting.

• County: Madison County, Illinois
• ZIP codes: 62025, 62034, 62234, 62040, 62002, 62035
• Nearby hospitals: Anderson Hospital in Maryville; Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton; Gateway Regional Medical Center in Granite City; HSHS St. Joseph's Hospital in Highland (not affiliated with Gateway)
• Nearby communities: Edwardsville, Glen Carbon, Collinsville, Granite City, Alton, Godfrey, Illinois
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Madison County

Read the full guide to reopened surgical wounds, or see everything Gateway arranges on the mobile wound care in Madison County 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 Edwardsville
• Care for a reopened surgical wound in Glen Carbon
• Care for a reopened surgical wound in Collinsville
• Care for a reopened surgical wound in Granite City

Common questions