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.
Local context: Kirkwood
People in Kirkwood 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.
Kirkwood is an established St. Louis County suburb that grew up along Kirkwood Road (the local name for Lindbergh Boulevard) south of Manchester Road. Interstate 44 crosses the south side and Interstate 270 is a short drive west. The city has a walkable downtown near the train station and block after block of older homes under mature trees. Many people here have lived in the same house for decades and intend to stay. When a wound or a long-term health problem makes trips out harder, care arranged at home or in a nearby facility helps them do that.
Care at home
Most of the work on a dehisced wound happens between clinician visits. Someone has to change the dressing on the schedule the clinician ordered, and after abdominal or back surgery the patient often cannot see or reach the incision alone. That job usually falls to a spouse, an adult child or a visiting nurse. The clinician can show a caregiver what the orders involve and what a normal dressing looks like when it comes off. It helps to keep a simple log with the date, how wet the old dressing was and anything that looked different. Bring the log and your questions to the next visit.
Care in skilled nursing and assisted living
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.
What to report and when to call 911
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.
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.
Getting care arranged in Kirkwood
Clinicians and facility staff referring a patient for care for a reopened surgical wound in Kirkwood 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.
Before you call 314-325-0126, it helps to have the patient’s name, the Kirkwood address or facility name, a phone number and the name of the regular doctor. If there was a recent hospital or rehab stay, tell us where it was and when it ended. Gateway also arranges care in nearby Webster Groves, Des Peres, Crestwood, Sunset Hills, Manchester and Valley Park, so relatives in two nearby towns can be discussed in one call. Visit days are confirmed for each address once a partner clinician is identified.
- County: St. Louis County, Missouri
- ZIP codes: 63122
- Nearby hospitals: St. Luke's Des Peres Hospital; Missouri Baptist Medical Center in Town and Country; Mercy Hospital South; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
- Nearby communities: Webster Groves, Des Peres, Crestwood, Sunset Hills, Manchester, Valley Park
- 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 Kirkwood 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 Webster Groves
Common questions
Do I need a referral to arrange dehisced wound care in Kirkwood?
No. Patients, family members and caregivers in Kirkwood 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.
How often does the dressing on an open incision need changing?
It varies with the wound and the dressing. A heavily draining wound may need a change once or more each day early on, while some dressings are designed to stay in place for several days. The treating clinician sets the schedule in the orders and usually spaces changes out as drainage slows. If a dressing leaks through or comes loose before its time, let the clinician or nurse know.
Will Medicare or my health plan pay for care for a reopened incision in Kirkwood?
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 Kirkwood, Gateway confirms the treating provider first and suggests you verify benefits with your plan before care starts.
Can Gateway arrange visits for a resident of an assisted living community in Kirkwood?
Yes, you can ask. Gateway arranges wound care and primary care visits by partner clinicians in assisted living, memory care and skilled nursing settings in Kirkwood. The resident, a family member or the facility’s nurse can make the request. We coordinate with facility staff so that the treating clinician’s orders and visit notes reach the people who help with daily care.
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.