Understanding 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.

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 Mehlville

People in Mehlville 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.

Mehlville is not a city with its own city hall. It is an unincorporated part of South County, governed by St. Louis County, with mail addressed to St. Louis. Lemay Ferry Road runs through the middle of it, Interstate 55 passes alongside, and Lindbergh Boulevard and the interchange with Interstates 255 and 270 are close by. The neighborhoods are settled, and many households have been here for a generation or more. As those residents get older, wound care and primary care arranged at home or in a local facility become a practical way to stay put.

Care 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.

For residents of nursing and senior living communities

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.

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.

Primary care and overall health

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 Mehlville →

Getting care arranged in Mehlville

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

Since Mehlville addresses say St. Louis, give us the ZIP code (63125 or 63129) and the nearest main road when you call, so there is no confusion with the city. Keep the patient’s phone number, doctor’s name and medication list close at hand. Gateway arranges care in nearby Oakville, Affton, Arnold, the rest of South County and South St. Louis. If relatives in different households share the caregiving, tell us who should get the call about visit days.

  • County: St. Louis County, Missouri
  • ZIP codes: 63125, 63129
  • Nearby hospitals: Mercy Hospital South (not affiliated with Gateway)
  • Nearby communities: Oakville, Affton, South County, Arnold, South St. Louis
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Mehlville

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

Common questions

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

No. Patients, family members and caregivers in Mehlville 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.

Can physical therapy continue while the incision is open?

Frequently it can, with changes. After a joint replacement or heart surgery, movement is part of recovery, and stopping it completely carries its own risks. The surgeon and the therapist decide which exercises, ranges of motion and weight limits are safe while the wound is open. Let your therapist know as soon as an incision separates, and tell the treating clinician what therapy involves so the dressing can be chosen to stay put.

Can my dad in Mehlville have wound care and primary care arranged together?

You can ask for both. Gateway arranges wound care and primary care with partner clinicians, and many people with chronic wounds also need follow-up for diabetes, circulation or heart conditions. Whether one clinician or two are involved depends on your dad’s needs and his location in Mehlville. Either way, we share records and orders across the care team so everyone works from the same information.

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.