About reopened surgical wounds

Once an incision has opened, the usual path is what clinicians call healing by secondary intention. Instead of the edges being joined, the gap fills from the base with new red, bumpy tissue, the wound draws inward, and skin grows across from the sides. That happens in stages over weeks, and for larger or deeper openings it can run into months. Early on, drainage may be heavy and dressing changes frequent. As the wound fills, drainage usually lessens and the opening measures smaller. Progress is rarely a straight line. A wound may stall, form a pocket under one edge, or need unhealthy tissue cleared before it moves again. The scar that results is often wider than the original line.

What an assessment covers

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.

Arranging this care in the Metro East

Some people in the Metro East have surgery at an Illinois hospital and recover with Illinois home health. Others cross the river for an operation in St. Louis and then come home. Either way, a dehisced wound needs a treating clinician who can see patients on the Illinois side and who works with your plan. Illinois Medicaid and Missouri Medicaid are separate programs, and Medicare Advantage and commercial plans can differ by state. Before a visit is scheduled, Gateway confirms the treating provider and encourages you to check your benefits with the plan.

The Metro East is the Illinois side of the St. Louis region: St. Clair, Madison and Monroe counties, running from Alton and Godfrey in the north to Columbia and Waterloo in the south. It takes in river towns on the floodplain, older cities such as Belleville and Granite City, growing suburbs like Edwardsville and O’Fallon, and farm communities to the east. A good deal of the region’s specialty care sits across the river in Missouri, and a bridge crossing is a real obstacle for someone who is frail or in pain. Care arranged close to home matters here.

When care happens 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.

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.

Signs to tell the clinician about

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.

Why primary care matters here

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 the Metro East →

How to get started in the Metro East

For a resident of a nursing home, assisted living or memory care community in the Metro East, a request for care for a reopened surgical wound can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

Because the Metro East covers three counties, the first thing we ask for is the town and ZIP code. After that, have a phone number, the type of residence, the patient’s doctors and the dates of any recent hospital stay ready. Gateway arranges care in Belleville, Edwardsville, O’Fallon, Collinsville, Alton and Granite City, among other communities. Distances are long from one end of the region to the other, so availability is confirmed by location and care setting for each request.

  • County: St. Clair, Madison and Monroe counties, Illinois
  • Nearby hospitals: Memorial Hospital Belleville; Memorial Hospital Shiloh; HSHS St. Elizabeth's Hospital in O'Fallon, Illinois; Anderson Hospital in Maryville; Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton; Gateway Regional Medical Center in Granite City; Touchette Regional Hospital in Cahokia Heights (not affiliated with Gateway)
  • Nearby communities: Belleville, Illinois, Edwardsville, O'Fallon, Illinois, Collinsville, Alton, Granite City
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in the Metro East

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

Common questions

Do I need a referral to arrange dehisced wound care in the Metro East?

No. Patients, family members and caregivers in the Metro East 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.

What is the difference between dehiscence and a surgical site infection?

Dehiscence describes a mechanical event: the edges of an incision have come apart. A surgical site infection means bacteria are multiplying in the wound. The two often travel together, since infection can cause an incision to open and an open incision can become infected, but each can occur without the other. The treating clinician checks for both, because an infected wound calls for a different plan than a clean one.

Can I shower with an open surgical wound?

Ask the surgical team or the treating clinician before you do, because the answer depends on how deep the wound is, what dressing is on it and whether a device is attached. Some people are cleared to shower with the dressing protected or just before a scheduled change. Soaking in a bathtub, pool or hot tub is generally off limits until the surgical team says otherwise. Follow the written instructions you were given.

Can I ask about Illinois Medicaid or a Medicare Advantage plan for care in the Metro East?

You can ask about Medicare, Medicare Advantage, Medicaid and commercial plans. Participation and benefits depend on the treating provider, the plan and the care needed, so coverage cannot be discussed without the plan details. Have the insurance card in hand when you call. Illinois and Missouri run separate Medicaid programs, so mention that the patient lives in Illinois.

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.