Understanding 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 an assessment covers

The treating clinician starts with the paperwork: what operation was done and when, how the incision was closed, what the surgeon ordered for dressings, bathing and activity, and when the next surgical appointment is. Then comes the wound itself. The clinician looks at whether the edges meet along the full length, measures any open area, notes the color and amount of drainage, and checks the surrounding skin for warmth, firmness or swelling. Stitches, staples and drains are checked against the surgeon’s removal plan. From there the clinician writes or updates orders that fit within the surgeon’s instructions, and Gateway sends the findings to the surgical office.

Local context: Edwardsville

Post-surgical follow-up for patients in Edwardsville often involves a Missouri surgeon, an Illinois home health agency and an Illinois health plan, each with its own rules about orders, supplies and authorizations. Gateway sorts out the treating provider and coverage questions first, because participation and benefits depend on the provider, the plan and the care needed. Then we coordinate dressing supplies and visit notes across the river. When the surgeon wants to see the incision in person, we can help arrange transportation so the bridge crossing is not what delays the appointment.

Housing in Edwardsville covers a wide range: brick homes on the older streets near downtown, mid-century ranches, large newer subdivisions, and apartments and condominiums for students, working families and older adults. Assisted living, memory care, skilled nursing and rehabilitation settings are part of the mix. Gateway arranges visits with partner clinicians across all of them. The steps are the same wherever the patient lives: we confirm the setting, agree on a time with the patient, the caregiver or the facility staff, and make sure the treating clinician receives the records and current orders before the visit.

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.

In a facility

Many people go from the hospital to a rehabilitation or skilled nursing stay after joint replacement, heart surgery or abdominal surgery. There, facility nurses do the daily dressing changes and therapists get the patient moving. A treating clinician arranged through Gateway assesses the incision on site, writes wound orders for the nursing staff to carry out and documents findings in a form the facility can file in its chart. The attending physician remains in charge of overall medical care, and the surgeon is kept informed of anything that departs from the expected course.

Signs to tell the clinician about

For a caregiver, the first hint of a wound problem is often the person, not the incision. Tell the treating clinician if you notice:

  • A temperature above the level named in the discharge papers
  • New tiredness, poor appetite or nausea
  • Swelling, hardness or a bulge beside the incision
  • A new smell when the dressing comes off
  • Skin around the tape turning red, blistered or raw

Call 911 right away for sudden confusion, fainting, a racing heartbeat with shaking chills, difficulty breathing, chest pain, or a wound that has split open or is bleeding heavily.

How primary care fits in

Repairing an incision takes protein, calories and fluids at a time when appetite is often poor. Pain medicine can cause nausea and constipation, and straining puts pressure on an abdominal incision. Weight loss after surgery is easy to miss in someone who is mostly resting. Primary care can look at eating, hydration, bowel function and weight, order labs if needed and involve a dietitian where appropriate. Wound care and primary care are arranged together because a clinician who sees slow healing needs someone to act on the nutrition side, and the reverse is equally true.

Primary care at home in Edwardsville →

How to get started in Edwardsville

Clinicians and facility staff referring a patient for post-surgical wound care in Edwardsville can call 314-325-0126 or fax 314-786-7966. Helpful to include: demographics and insurance, the working diagnosis, recent wound notes and measurements, current orders, the medication list and relevant test results. Please also tell us who should receive the treating clinician’s notes afterward. The online referral form takes contact details only, so clinical records should come by fax, not through the form. Gateway confirms that the referral arrived, checks availability for the patient’s address and lets your office know what has been scheduled.

Anderson Hospital in Maryville, a few miles south on Route 159, is the closest hospital to Edwardsville, and some residents are treated at hospitals in St. Louis as well. Gateway is not affiliated with Anderson Hospital. Families can call us before or after a discharge to ask about follow-up at home. Discharge planners and case managers can refer by phone or by fax at 314-786-7966. Either way, we collect the discharge summary and orders, confirm the address or facility the patient is returning to, and arrange the visit with a partner clinician.

More wound care in Edwardsville

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

Common questions

Can Gateway arrange care for a resident recovering from surgery in a facility in Edwardsville?

Yes. Gateway works with skilled nursing facilities, rehabilitation centers, assisted living and memory care communities. A partner clinician can assess the resident’s incision on site, and findings and orders go to facility nursing and the attending physician. Family members or facility staff can start the request. Availability is confirmed for each facility and location.

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.

Does wound follow-up replace my appointments with the surgeon?

No. The surgeon who did the operation remains responsible for it, and you should keep every scheduled post-operative appointment. Wound follow-up fills the time between those visits. The treating clinician assesses the incision, works within the surgeon’s orders and reports findings to the surgical office, which helps the surgeon decide whether to see you sooner.

My parents live in Edwardsville and I live in another state. Can I arrange care for them?

Yes. Family members can call 314-325-0126 from anywhere. Have your parents’ address, a local phone number and the name of their regular doctor ready, and let them know to expect a call. With their agreement, we can keep you informed about scheduling and follow-up as the family contact. The treating clinician will want to talk with your parents directly about their health and their wishes.

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.