What to know about reopened surgical wounds

An incision stays shut because the closure holds the edges still long enough for new tissue to bridge the gap. Anything that weakens that bridge, or pulls on it, can undo the work. Infection breaks down new tissue. A pocket of fluid or old blood under the skin keeps the layers from joining. Swelling stretches the line from inside. On the mechanical side, a hard coughing spell, vomiting, straining on the toilet, lifting or a fall can put sudden force across the closure. Location matters as well: incisions across the belly, over a joint that bends, or deep in a skin fold carry more tension and moisture than a line on flat, still skin. Usually more than one of these is at work at the same time.

How the care plan is built

Measurements matter more than impressions with an open surgical wound, so the treating clinician records the same points at each visit and compares them over time:

  • Length, width and depth of the opening
  • The kind of tissue in the base, and how much of it looks healthy
  • Any tunnel or pocket under the edges, and which direction it runs
  • How much drainage the dressing held, and its color
  • The condition of the surrounding skin

When the numbers shrink from visit to visit, the plan is working. When they hold still or grow, the clinician looks for a reason, such as infection, strain on the area or a dressing that no longer suits the wound, and adjusts the orders.

Arranging this care in South County

People in South County 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.

South County is shorthand for the southern part of St. Louis County, a band of communities roughly south of Interstate 44 that reaches from the River des Peres at the city line down to the Meramec River. It includes Affton, Lemay, Mehlville, Oakville, Concord, Sappington, Green Park, Crestwood and Sunset Hills. Gravois Road, Tesson Ferry Road, Lemay Ferry Road, Telegraph Road and Lindbergh Boulevard are the roads everyone uses. People here tend to stay for life, and many are retirees. Bringing wound care and primary care to them fits the way South County lives.

Care at home

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.

In a facility

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

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.

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 South County →

How to get started in South County

People asking about care for a reopened surgical wound in South County usually want to know what the first visit involves. Before it, Gateway collects the records the treating clinician asks for and confirms the time and place with you. During it, the clinician looks at the wound and the skin around it, measures it, asks about your health and medications and explains what they recommend. Afterward, the orders go to whoever does the daily care, supplies are requested and a follow-up is planned. Our guide to how mobile wound care visits work has more. To begin, call 314-325-0126. Whether a visit can be arranged is confirmed for your location.

South County is a patchwork of small cities and unincorporated neighborhoods, and nearly all of them use St. Louis as the mailing city. When you call, give the ZIP code and a nearby main road so we place the address correctly. Have the patient’s phone number, doctor’s name and insurance cards with you. Gateway arranges care in Affton, Mehlville, Oakville, Crestwood, Sunset Hills and Fenton, among others. If you are helping two relatives in different parts of South County, tell us, and we will take both requests together.

  • County: St. Louis County, Missouri
  • ZIP codes: 63123, 63125, 63126, 63127, 63128, 63129
  • Nearby hospitals: Mercy Hospital South; SSM Health St. Clare Hospital in Fenton; St. Luke's Des Peres Hospital (not affiliated with Gateway)
  • Nearby communities: Affton, Mehlville, Oakville, Crestwood, Sunset Hills, Fenton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in South County

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

Common questions

Will Medicare or my health plan pay for care for a reopened incision in South County?

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 South County, Gateway confirms the treating provider first and suggests you verify benefits with your plan before care starts.

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.

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.

Do patients in South County have to use Mercy Hospital South to work with Gateway?

No. Gateway is not affiliated with Mercy Hospital South or any hospital, and it does not matter where you were treated. You can ask for care after a stay at any hospital, after rehabilitation, at your doctor’s suggestion or on your own with no referral at all. We ask only for the records and orders that help the treating clinician understand your situation.

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.