What to know about reopened surgical wounds

Several common beliefs about reopened incisions do not hold up. The first is that an open incision must be stitched shut again at once. Surgeons often choose not to, because sealing skin over fluid or bacteria can trap an infection underneath. The second is that the wound should be left uncovered to dry out. Dressing choices belong to the treating clinician, and many open surgical wounds are deliberately kept covered and moist. The third is blame: people assume they caused it by moving wrong, when the tissue was usually fragile already. The last is that a small gap can wait until the next scheduled appointment. Even a short opening can be deeper than it looks from the surface, so report it when you first see it.

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.

Arranging this care in Florissant

People in Florissant who have a joint replacement or major abdominal surgery often spend a stretch in a nearby skilled nursing or rehabilitation center before returning home. A dehisced wound has to be followed across that move. Gateway coordinates so that the measurements, current dressing orders and the surgeon’s instructions go with the patient from the facility to the house, or from an independent apartment in a senior living community to its care wing. Supplies are a frequent gap on the day of discharge, so we confirm what is being sent home and what still needs to be ordered.

Florissant is one of the largest cities in North County, with a historic Old Town at its heart and decades of subdivisions spreading out from it. Lindbergh Boulevard cuts across the city, and New Halls Ferry Road links it to its neighbors. A great many of its homes are single-story ranches, bought by young families years ago and still occupied by the same owners. That makes Florissant a natural place for aging at home, and it makes home-based wound care and primary care especially useful as those owners need more medical attention.

When care happens at home

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.

Care in skilled nursing and assisted living

Assisted living communities differ in how much nursing care they can provide, and an open surgical wound can test those limits. Some have a nurse who can change a dressing daily. Others rely on a home health agency coming in. When a resident’s incision opens, Gateway asks the community what its staff can and cannot do, then arranges the treating clinician’s visits and any outside nursing around that answer. Aides who help with bathing and dressing need the basics from the clinician’s orders as well: how the dressing is protected during a shower, how to avoid pulling on the area during transfers, and whom to tell if it is soaked or loose.

Changes to report

If you change the dressing for someone else, you will see the wound more often than anyone on the care team. Pass these along to the treating clinician when you see them:

  • The old dressing is far wetter than usual
  • Drainage has turned thick, green, tan or bloody
  • A new opening has appeared farther along the incision line
  • The skin around the wound is hot, hard or more swollen
  • Pain is climbing despite the usual pain plan
  • New tiredness, fever or loss of appetite

Call 911 for a wide opening of a belly incision, tissue pushing out of the wound, heavy bleeding, fainting 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 Florissant →

Arranging care for a reopened surgical wound in Florissant

Before anything is scheduled, Gateway checks two things for every request for care for a reopened surgical wound in Florissant: whether a partner clinician serves that address and care setting, and what the patient’s plan requires from the treating provider. Neither is assumed. If both line up, we arrange the visit and gather records. If something stands in the way, we say so, and our guide to following up on a request explains what to ask next. Gateway coordinates the care and does not make clinical decisions. Those belong to the treating clinician who sees the wound. Start by calling 314-325-0126, or ask a family member to call for you.

Florissant is big enough that location within the city matters. Tell us the ZIP code, the nearest major road and whether the home is north toward the Missouri River or south near Interstate 270. Have the patient’s phone number, the doctor’s name and the name of a second contact. Ask us about timing if a caregiver is only there at certain hours. Gateway also arranges care in Hazelwood, Ferguson, Bridgeton and the rest of North County, and visits in Florissant are planned with those areas.

  • County: St. Louis County, Missouri
  • ZIP codes: 63031, 63033, 63034
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Hazelwood, Ferguson, North County, Bridgeton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Florissant

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

Common questions

Will Gateway arrange wound visits at a rehabilitation or nursing facility in Florissant?

Yes, where a partner clinician is available for that setting. Gateway arranges wound visits in skilled nursing, rehabilitation, assisted living and memory care communities in Florissant, working with the facility’s nurses and the attending physician. A facility can send a referral by fax to 314-786-7966, or a family member can call us and we will contact the facility. Visit availability is confirmed for each location.

Is the area weaker after a dehisced wound finally closes?

Often, yes. A wound that fills in from the base leaves scar tissue that is less strong than uninjured skin, and it keeps maturing long after the surface has closed. After abdominal surgery, a weak spot in the deeper layer can later show up as a bulge near the scar, called an incisional hernia. Tell your surgeon or primary care clinician if you notice one, and ask the surgeon when lifting and exercise can resume.

Does every dehisced wound need a wound vac?

No. Negative pressure wound therapy, often called a wound vac, is one tool the treating clinician may order, usually for wounds that are deep, drain heavily or have a lot of space to fill. Many reopened incisions, especially shallow ones, are managed with ordinary dressings alone, and the device is not suitable for every wound. If one is ordered, Gateway helps coordinate the equipment, the supplies and the nursing visits it requires.

How are wound care supplies handled for a patient at home in Florissant?

The treating clinician decides which dressings and supplies are needed and writes the orders. Gateway coordinates getting those orders to a supplier and tracks the follow-up, so the family is not left making calls. What a plan pays for depends on the plan and the order. Let us know if a delivery to your Florissant address is late or something in the box looks different from before.

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.