About 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

Looking after a reopened incision is shared work, and the treating clinician sorts out early who decides what. Typically:

  • The surgeon decides anything about the operation itself, including whether the wound is closed again later
  • The treating clinician decides dressings, visit frequency and bedside wound care
  • Nurses or trained caregivers carry out dressing changes between visits

At follow-up visits the clinician rechecks the wound against the last measurements, removes unhealthy tissue if that is needed and suitable for the setting, and prepares an update for the surgical office. If the wound deepens, exposes deeper layers or stops improving, the clinician contacts the surgeon instead of waiting for the next routine appointment.

Arranging this care in Jefferson County

In Jefferson County, the hospital where the operation was done may be a long way from home, and a wound specialist may be no closer. For a dehisced incision that has to be measured and redressed on a regular schedule, that distance is the main obstacle. Gateway arranges home visits from a partner clinician where that is available, and visit days are planned ahead. Supplies get the same attention. We keep track of how many dressings and wound therapy canisters are on hand, because a replacement shipment to a rural address is not always quick.

South of the Meramec River, St. Louis County gives way to Jefferson County, a wide stretch of hills, creek valleys and growing towns. Interstate 55 lines the east side through Arnold, Imperial, Barnhart and on to Festus and Crystal City. Route 30 serves High Ridge and House Springs in the north, and Route 21 heads down to Hillsboro, the county seat, and De Soto. Much of the county is rural once you leave those corridors. Home and facility visits matter here because the alternative is often a long drive on winding roads for every appointment.

When care happens 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

In a facility, wound orders live in the resident’s chart and go through the attending physician. A partner clinician who visits for a reopened incision documents the assessment, recommends or writes orders according to the facility’s process, and leaves clear instructions for the nurses who will do the dressing changes. Gateway handles the scheduling with the nursing leadership, requests surgical records the facility may not have received, and coordinates with the surgeon’s office about follow-up appointments. That last piece matters, because a trip out to the surgeon means transportation, an escort and a dressing that will hold up through the ride.

What to report and when to call 911

Whoever looks after the wound, whether family at home or nurses in a facility, should know which findings cannot wait for the next scheduled visit. Report to the treating clinician:

  • Wound edges that were pink turning dark, gray or black
  • A pocket or tunnel that is new or deeper
  • A sudden increase in drainage or a strong odor
  • Fever, chills or a racing heartbeat
  • A wound therapy pump that alarms repeatedly or loses its seal

Call 911 when an abdominal wound separates widely or its contents push through, when bleeding will not stop, or when there is chest pain, labored breathing, collapse or sudden confusion.

How primary care fits in

New tissue is built from what the bloodstream delivers, so the conditions a primary care clinician manages have a direct line to a reopened incision. High blood sugar slows the cells that rebuild tissue and fight bacteria. Narrowed arteries deliver less oxygen to an incision on the leg or foot. Swelling from heart, kidney or vein problems stretches the skin around a wound and keeps it wet. None of these can be fixed with a dressing. When Gateway arranges wound care, we can also help arrange primary care with a partner clinician, so that the person measuring the wound and the person managing those conditions are sharing information.

Primary care at home in Jefferson County →

How to get started in Jefferson County

Setting up care for a reopened surgical wound for someone in Jefferson 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.

When you call about care in Jefferson County, tell us the town and ZIP code first, since Arnold (63010) and De Soto (63020) are very different drives. Then give the street address, turn-by-turn directions if the home is rural, and a phone number that gets a signal there. Mention steep or unpaved driveways. Visits are planned by area, and Gateway arranges care in Arnold, Imperial, Festus and Crystal City as well as neighboring Fenton and Oakville. Bad weather on hill roads can occasionally move a visit, and we will call if it does.

  • County: Jefferson County, Missouri
  • ZIP codes: 63010, 63028, 63019, 63052, 63012, 63050, 63020, 63049, 63051
  • Nearby hospitals: Mercy Hospital Jefferson in Festus; Mercy Hospital South; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
  • Nearby communities: Arnold, Festus and Crystal City, Imperial, Fenton, Oakville
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Jefferson County

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

Common questions

Will Medicare or my health plan pay for care for a reopened incision in Jefferson County?

You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Whether a visit, a dressing supply or a wound therapy device is a covered benefit depends on the treating provider, your plan and the care the clinician orders, so we cannot tell you in advance that something will be paid for. For patients in Jefferson County, Gateway confirms the treating provider first and suggests you verify benefits with your plan before care starts.

Do I need a referral to arrange dehisced wound care in Jefferson County?

No. Patients, family members and caregivers in Jefferson County can call Gateway directly, with or without a referral. We will ask who performed the surgery and when, so that the operative records and the surgeon’s current instructions can be requested for the treating clinician. Some health plans have their own referral rules, so it is worth asking your plan whether one is required for wound care visits.

Can someone come to a home in Jefferson County to check a surgical incision that has opened?

In many cases, yes. Gateway arranges home visits with partner clinicians for people in Jefferson County whose incision has separated, and the clinician examines the wound in the room where you are recovering. Availability is confirmed by location and care setting, so the first step is a call to 314-325-0126. If the incision has just opened and your surgeon does not know yet, call the surgical office as well.

Does it matter which hospital a Jefferson County patient is discharged from?

Not for requesting follow-up. Whether the stay was at Mercy Hospital Jefferson, Mercy Hospital South, SSM Health St. Clare Hospital or a hospital farther away, Gateway asks for the discharge records and wound orders in the same way. Gateway is independent of all of them. What matters more is the address the patient is returning to in Jefferson County and whether that is a home or a facility.

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.