Understanding 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

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.

Local context: St. Charles

Newer subdivisions in St. Charles 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.

St. Charles is the historic county seat of St. Charles County, set on the bank of the Missouri River across from St. Louis County. The brick-paved Main Street district and the old neighborhoods near the riverfront are the oldest part of town, and newer subdivisions extend west and south from there. Interstate 70 and Routes 364 and 370 cross the river on separate bridges. For an older adult in St. Charles, a medical appointment on the other side of one of those bridges can take up half a day. Care at home changes that.

Care at home

Supplies for an open surgical wound add up quickly: packing or filler material, cover dressings, tape or wraps, wound cleanser and gloves. Once the treating clinician writes the orders, Gateway coordinates the supply request so the ordered items can be sent to the house, and updates it when the orders change. Running out over a weekend is a common and avoidable problem, so tell us when you are down to a few days of dressings. The house itself matters too. A bed that is hard to get out of, a low chair or a laundry basket that needs carrying can all strain a fresh abdominal or hip incision. Mention those obstacles during the visit.

In a facility

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.

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.

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 St. Charles →

How to get started in St. Charles

If you have been managing a wound mostly on your own and are looking for care for a reopened surgical wound in St. Charles, you can call Gateway yourself at 314-325-0126. Tell us what the wound looks like now, what the last clinician said about it and what is getting harder to manage. It helps to know the patient’s insurance and the names of the doctors involved, but do not wait until you have everything. We check whether a partner clinician can see the patient at home or in their facility, and we tell you what we find. The treating clinician takes it from there, and you stay part of the conversation.

A little preparation helps. Write down the patient’s full address in St. Charles with the ZIP code (63301, 63303 or 63304), a phone number, the regular doctor and pharmacy, and any recent hospital or rehab stay. Gateway also arranges care in St. Peters, Cottleville, Weldon Spring and the rest of St. Charles County, and across the river in Bridgeton. Some addresses with a St. Charles ZIP code are outside the city limits, so a few words about how to find the house are useful when visit days are confirmed.

  • County: St. Charles County, Missouri
  • ZIP codes: 63301, 63303, 63304
  • Nearby hospitals: SSM Health St. Joseph Hospital in St. Charles; Barnes-Jewish St. Peters Hospital (not affiliated with Gateway)
  • Nearby communities: St. Peters, St. Charles County, Bridgeton, Cottleville, Weldon Spring
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

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

Common questions

Can someone come to a home in St. Charles to check a surgical incision that has opened?

In many cases, yes. Gateway arranges home visits with partner clinicians for people in St. Charles whose incision has separated, and the clinician examines the wound in the room where you are recovering. Availability is confirmed by location and care setting, so the first step is a call to 314-325-0126. If the incision has just opened and your surgeon does not know yet, call the surgical office as well.

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.

Should I wear an abdominal binder over a reopened incision?

Only if your surgeon or the treating clinician recommends one. Binders are sometimes ordered after abdominal surgery to support the area during coughing and movement, but they are not right for everyone, and a binder that rubs or traps moisture can irritate an open wound or shift the dressing. If the hospital sent you home with one, ask whether to keep using it now that the incision has opened.

Can a home health nurse and a Gateway partner clinician both be involved for a patient in St. Charles?

Often, yes. Some patients in St. Charles have a home health agency providing nursing visits after a hospital stay. Tell us which agency is involved. With permission, Gateway shares the treating clinician’s orders and visit notes with the agency so the nurses and the clinician work from the same plan. How the services fit together under a given health plan depends on the plan and the care needed.

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.