About reopened surgical wounds

Dehiscence is the term clinicians use when a surgical incision separates after it has been closed. The closure might have been stitches, staples, adhesive strips or skin glue. In a partial dehiscence, only the skin and the fatty layer just beneath it come apart, and the gap may be no longer than a fingertip. In a deeper one, the strong layer that holds the muscles together also gives way, which is a more serious problem and belongs with the surgeon right away. Most reopened incisions show up while the person is still in the early weeks of recovery, often around the time staples or stitches come out. Some open all at once. Others begin as a small damp spot along the line that slowly widens.

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.

Care for a reopened surgical wound in Lake St. Louis

Newer subdivisions in Lake St. Louis tend to have two-story homes with the main bedroom upstairs and the laundry a floor away, which matters when the surgeon has limited lifting and stairs. The treating clinician can talk through where rest and dressing changes will happen for now. Senior living communities are part of the picture in outer suburbs too, and we arrange visits there as well as in private homes. With specialists farther away, good communication does more of the work: after each visit, Gateway coordinates an update to the surgical office, so some questions can be settled without a drive.

Two lakes shape daily life in Lake St. Louis. The city was planned around them in western St. Charles County, in the stretch between Interstate 70 on the north and Interstate 64 on the south, with Wentzville to the west and O’Fallon to the east. It started as a lake community and still draws people who want to retire near the water. Many residents are older adults, and some live alone. Wound care and primary care that come to the home help them stay where they are.

At home between visits

Many people come home from surgery with a home health agency already in place. When an incision opens, Gateway coordinates the wound care visits with that agency so the nurse and the treating clinician are following one set of orders, not two. If the clinician orders a wound therapy device, the agency nurse typically handles its scheduled dressing changes, and we help with the paperwork and delivery arrangements for the pump and its supplies. If no agency is involved and the wound needs skilled dressing changes several times a week, the treating clinician can decide whether a home health referral makes sense.

For residents of nursing and senior living communities

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

Some changes come on gradually and some arrive in a moment. A pop or tearing feeling at the incision, followed by a gush of pink fluid, can mean deeper layers are separating, and the surgeon should hear about it right away. Also report:

  • A bulge under or beside the incision when you cough or stand
  • Drainage that soaks through a fresh dressing quickly
  • Red streaks, or warmth that has moved beyond the dressing border
  • Shaking chills or a raised temperature

Call 911 if the wound opens wide, if you can see tissue or organs coming through it, or if you are short of breath, faint or bleeding heavily.

How primary care fits in

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 Lake St. Louis →

Getting care arranged in Lake St. Louis

Before anything is scheduled, Gateway checks two things for every request for care for a reopened surgical wound in Lake St. Louis: 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.

When you call about someone in Lake St. Louis, have the street address and subdivision or building name, a phone number and the names of the doctors already involved. Mention it if the patient spends part of the year elsewhere or stays with family some weeks. Gateway also arranges care in Wentzville, O’Fallon, Dardenne Prairie and the rest of St. Charles County. Lake St. Louis is toward the western end of the region we cover, so visit days are confirmed by location, and it helps to call early.

  • County: St. Charles County, Missouri
  • ZIP codes: 63367
  • Nearby hospitals: SSM Health St. Joseph Hospital in Lake Saint Louis; Progress West Hospital in O'Fallon (not affiliated with Gateway)
  • Nearby communities: Wentzville, O'Fallon, Missouri, Dardenne Prairie, St. Charles County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Lake St. Louis

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

Common questions

Do I need a referral to arrange dehisced wound care in Lake St. Louis?

No. Patients, family members and caregivers in Lake St. Louis 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.

Will Medicare or my health plan pay for care for a reopened incision in Lake St. Louis?

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 Lake St. Louis, Gateway confirms the treating provider first and suggests you verify benefits with your plan before care starts.

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.

Does Gateway work with SSM Health St. Joseph Hospital in Lake Saint Louis?

Gateway is an independent company and is not affiliated with SSM Health St. Joseph Hospital in Lake Saint Louis or any other hospital. Patients discharged from that hospital, and its discharge planners, are welcome to contact us about follow-up wound care or primary care at home. We ask for the discharge summary and current orders so the treating clinician can review them before the first visit.

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.