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.

Local context: St. Louis City

People in the City of St. Louis often live a short distance from the hospital where they had surgery, yet close is not the same as easy. Getting to a large medical center means a ride, a parking garage, long corridors and a wait in a chair, all with an open incision under your clothes. Gateway arranges wound visits in the apartment or house instead, and coordinates with the surgeon’s office so that in-person surgical appointments are saved for when the surgeon needs to examine the wound. If your building has an unreliable elevator or a locked entrance, mention it when you call.

The City of St. Louis is its own jurisdiction, separate from St. Louis County, and stretches from the Mississippi riverfront west to Forest Park and the county line. Inside it are dozens of distinct neighborhoods, from Downtown and Soulard to the Central West End, The Hill and the north side. The city is dense, old and largely built of brick, and many households do not have a car. For someone managing a wound or several chronic conditions, getting to appointments by bus or by borrowed ride is a recurring struggle that care at home can ease.

When care happens 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.

For residents of nursing and senior living communities

Many people who develop a dehisced wound are already in a skilled nursing or rehabilitation center after a joint replacement, an abdominal operation or heart surgery. Therapy is the reason they are there, and therapy is also what loads the incision. When Gateway arranges a wound visit in a facility, the treating clinician shares findings with the nursing staff and the therapy team, so that transfers, walking practice and exercises fit whatever limits the surgeon and attending physician have set. Facility nurses carry out the ordered dressing changes, and they are usually the first to notice when the drainage or the wound edges change.

What to report and when to call 911

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.

Primary care and overall health

After surgery, people need to move enough to protect their lungs, legs and strength, but not in ways that pull on the incision. Finding that balance is easier when someone is looking at the whole person. A primary care clinician can review pain control, sleep, mood, fall risk and the equipment that makes moving safer, and can talk with you about tobacco, which narrows small blood vessels and slows wound repair. Other health problems do not pause while an incision heals, and a flare of heart or lung disease can set recovery back. That is why Gateway can arrange primary care visits in the same home or facility where the wound is being followed.

Primary care at home in the City of St. Louis →

Arranging care for a reopened surgical wound in the City of St. Louis

Before anything is scheduled, Gateway checks two things for every request for care for a reopened surgical wound in the City of St. Louis: 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.

An address that says St. Louis can be in the city or the county, so give the ZIP code and neighborhood when you call. Have a reliable phone number, the name of the patient’s doctor or health center, and any discharge papers. Gateway arranges care throughout the City of St. Louis, including Downtown, the Central West End, North St. Louis and South St. Louis, and in Clayton and Central County next door. Building access and parking affect visits here more than distance does, so tell us about entry doors, buzzers and elevators.

  • County: City of St. Louis, Missouri (an independent city)
  • ZIP codes: 63101, 63103, 63104, 63106, 63108, 63109, 63110, 63111, 63112, 63113, 63115, 63116, 63118, 63139, 63147
  • Nearby hospitals: Barnes-Jewish Hospital; SSM Health Saint Louis University Hospital (not affiliated with Gateway)
  • Nearby communities: Downtown St. Louis, Central West End, North St. Louis, South St. Louis, Clayton and Central County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in the City of St. Louis

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

Common questions

Do I need a referral to arrange dehisced wound care in the City of St. Louis?

No. Patients, family members and caregivers in the City of St. Louis 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.

Will Gateway arrange wound visits at a rehabilitation or nursing facility in the City of St. Louis?

Yes, where a partner clinician is available for that setting. Gateway arranges wound visits in skilled nursing, rehabilitation, assisted living and memory care communities in the City of St. Louis, working with the facility’s nurses and the attending physician. A facility can send a referral by fax to 314-786-7966, or a family member can call us and we will contact the facility. Visit availability is confirmed for each location.

Can a social worker or community health worker in the City of St. Louis refer someone to Gateway?

Yes. Hospitals, clinics, facilities, social workers and community health workers can refer by calling 314-325-0126 or faxing 314-786-7966. Patients and family members can also call on their own. Please include a phone number where the patient or a relative can be reached, since scheduling depends on making contact. Gateway confirms availability for the patient’s address in the City of St. Louis and updates the person who referred.

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.