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.

How the care plan is built

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 O’Fallon

Some people in O’Fallon 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.

O’Fallon, Illinois is a St. Clair County city on Interstate 64, with Shiloh to the south, Fairview Heights to the west and Lebanon farther east. Scott Air Force Base is nearby, and many households have a tie to it, from active-duty families to retirees who decided to stay. The city has grown outward from its old downtown into wide areas of newer subdivisions. Even with a hospital in town, regular trips for wound care or follow-up visits are tiring for someone who is recovering or frail, and care arranged at home or in a facility spares them that.

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.

Care in skilled nursing and assisted living

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

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.

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 O'Fallon →

Getting care arranged in O’Fallon

Clinicians and facility staff referring a patient for care for a reopened surgical wound in O’Fallon 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.

Say “O’Fallon, Illinois” and give the ZIP code 62269 when you call, since there is an O’Fallon in Missouri too. Have the street address, a phone number, the discharge date if there was a hospital stay, and the names of the patient’s doctors. Gateway also arranges care in Fairview Heights, Belleville, Collinsville and other parts of St. Clair County. O’Fallon is easy to reach from Interstate 64, but availability still depends on location and care setting, and we confirm it before scheduling.

More wound care in O’Fallon

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

Common questions

Do I need a referral to arrange dehisced wound care in O’Fallon?

No. Patients, family members and caregivers in O’Fallon 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.

Is the area weaker after a dehisced wound finally closes?

Often, yes. A wound that fills in from the base leaves scar tissue that is less strong than uninjured skin, and it keeps maturing long after the surface has closed. After abdominal surgery, a weak spot in the deeper layer can later show up as a bulge near the scar, called an incisional hernia. Tell your surgeon or primary care clinician if you notice one, and ask the surgeon when lifting and exercise can resume.

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 a military retiree or a service member’s relative living in O’Fallon request care?

Yes. Anyone in O’Fallon can call Gateway to ask about care, with or without a referral. Have the insurance card available. You can ask about Medicare, Medicare Advantage, Medicaid and commercial plans, and whether a particular plan applies depends on the treating provider, the plan and the care needed. If family members are deployed or live elsewhere, tell us who the local contact should be.

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.