Post-surgical wound care in the City of St. Louis.

Understanding post-surgical wounds

In the first days, an incision is usually tender, slightly swollen and pink along its edges, and it may leak a little clear or pale pink fluid. Over the following weeks the surface seals, a firm ridge often forms underneath, and stitches or staples come out when the surgeon says so. The scar then keeps remodeling for many months, slowly flattening and fading, and it stays weaker than uninjured skin for a long time. Wounds left open follow a different path: they fill with new red tissue from the bottom and shrink gradually. Problems tend to show up in the first few weeks, though an incision can open or drain later, especially after strain or an infection.

How the care plan is built

The treating clinician starts with the paperwork: what operation was done and when, how the incision was closed, what the surgeon ordered for dressings, bathing and activity, and when the next surgical appointment is. Then comes the wound itself. The clinician looks at whether the edges meet along the full length, measures any open area, notes the color and amount of drainage, and checks the surrounding skin for warmth, firmness or swelling. Stitches, staples and drains are checked against the surgeon’s removal plan. From there the clinician writes or updates orders that fit within the surgeon’s instructions, and Gateway sends the findings to the surgical office.

Arranging this care in the City of St. Louis

In the City of St. Louis, many people recover from surgery in apartments or older two- and three-story homes, and stairs are the first obstacle. Lifting limits after abdominal, chest or joint surgery can make a walk-up hard to leave, so follow-up that comes to the door spares the incision a trip. Before a visit, Gateway asks about buzzers, entry codes and parking so the treating clinician can reach you. Large hospitals are close, which helps when the surgeon wants to see a wound in person, and we can help arrange transportation when that trip is needed.

Almost every kind of housing is found in the City of St. Louis: single-family brick homes, two-family and four-family flats, downtown lofts, high-rise apartments, senior housing towers and large older homes divided into units. It also has many skilled nursing facilities, assisted living residences and rehabilitation centers. Gateway arranges partner clinician visits in all of these. For a high-rise, we ask about the front desk and where to park. For a flat, we ask which bell to ring. We collect those details so the treating clinician can focus on the patient.

At home between visits

Supplies are where home recovery often goes wrong. The hospital sends you home with a few days of dressings, and then the gauze, tape or drain supplies run out over a weekend. Once the treating clinician writes an order, Gateway follows up with the supplier so the right items in the right sizes arrive before they are needed, and we check again when the order changes. If a negative pressure device is part of the plan, we help coordinate delivery, canister and dressing-kit resupply, and the question of who changes it.

For residents of nursing and senior living communities

A resident with dementia may not remember having surgery, may pull at a dressing or pick at staples, and may not be able to say that an incision hurts. In memory care, the treating clinician relies on staff observations and plans for these realities, for example with a dressing that is harder to remove and clothing that covers the site. Staff are told which behaviors, such as new restlessness, guarding one side or refusing to walk, might signal a wound problem. Gateway keeps the family or legal representative updated and sends findings to the attending physician and the surgeon.

Signs to tell the clinician about

Report these changes to the surgeon’s office or the treating clinician without waiting for the next visit:

• Redness that widens around the incision or streaks away from it
• Drainage that becomes thicker, cloudy or foul-smelling
• A gap opening between the edges
• Fever, chills or feeling newly unwell
• Pain that climbs after it had been easing

Call 911 if the incision bursts open and deeper tissue or an organ is visible, if bleeding will not stop with steady pressure, or if chest pain, shortness of breath, fainting or sudden confusion develops.

Why primary care matters here

Repairing an incision takes protein, calories and fluids at a time when appetite is often poor. Pain medicine can cause nausea and constipation, and straining puts pressure on an abdominal incision. Weight loss after surgery is easy to miss in someone who is mostly resting. Primary care can look at eating, hydration, bowel function and weight, order labs if needed and involve a dietitian where appropriate. Wound care and primary care are arranged together because a clinician who sees slow healing needs someone to act on the nutrition side, and the reverse is equally true.

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

How to get started in the City of St. Louis

Before anything is scheduled, Gateway checks two things for every request for post-surgical wound care 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.

Barnes-Jewish Hospital, beside Forest Park, and SSM Health Saint Louis University Hospital, on Grand Boulevard, are the two major hospitals in the City of St. Louis. Gateway is not affiliated with either. Both discharge patients to every part of the city, and some go home with wounds that need regular attention. Case managers and social workers can refer by phone at 314-325-0126 or by fax at 314-786-7966. Families can call directly. Once we have the discharge summary and orders, we look for a partner clinician for the patient’s neighborhood and report back.

• 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 post-surgical wounds, or see everything Gateway arranges on the mobile wound care in the City of St. Louis page.

• Diabetic foot ulcers
• Venous leg ulcers
• Pressure injuries and bed sores
• Arterial and mixed wounds
• Non-healing wounds
• Reopened (dehisced) surgical wounds
• Surgical site infections
• Skin tears and traumatic wounds
• Wounds with lymphedema
• Skin graft aftercare
• Wound VAC (NPWT) follow-up
• Post-surgical wound care in Downtown St. Louis
• Post-surgical wound care in the Central West End
• Post-surgical wound care in North St. Louis
• Post-surgical wound care in South St. Louis

Common questions