About 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

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.

Local context: St. Peters

Newer subdivisions in St. Peters 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.

Interstate 70 carries most of the traffic through St. Peters, a St. Charles County city set between St. Charles to the east and O’Fallon to the west. Mid Rivers Mall Drive is the main north-south route, lined with shopping centers, and subdivisions fill in the blocks behind it. It is a car-dependent place. When a wound, weakness or a recent surgery makes getting in and out of a car hard, even a short drive to an appointment becomes a project. Care that comes to the home or facility takes the car out of the picture.

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.

For residents of nursing and senior living communities

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

If you change the dressing for someone else, you will see the wound more often than anyone on the care team. Pass these along to the treating clinician when you see them:

  • The old dressing is far wetter than usual
  • Drainage has turned thick, green, tan or bloody
  • A new opening has appeared farther along the incision line
  • The skin around the wound is hot, hard or more swollen
  • Pain is climbing despite the usual pain plan
  • New tiredness, fever or loss of appetite

Call 911 for a wide opening of a belly incision, tissue pushing out of the wound, heavy bleeding, fainting or sudden confusion.

How primary care fits in

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 St. Peters →

Arranging care for a reopened surgical wound in St. Peters

To arrange care for a reopened surgical wound in St. Peters, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.

Before calling Gateway at 314-325-0126, gather a few things: the St. Peters street address, a good callback number, the name of the patient’s doctor, and discharge papers if there was a recent hospital or rehab stay. An insurance card is useful for coverage questions. We also coordinate care in St. Charles, O’Fallon, Cottleville, Weldon Spring and elsewhere in St. Charles County. Visit availability is confirmed by location and care setting, so tell us whether the patient is at home or in a facility.

  • County: St. Charles County, Missouri
  • ZIP codes: 63376
  • Nearby hospitals: Barnes-Jewish St. Peters Hospital; SSM Health St. Joseph Hospital in St. Charles; Progress West Hospital in O'Fallon (not affiliated with Gateway)
  • Nearby communities: St. Charles, O'Fallon, Missouri, Cottleville, Weldon Spring, St. Charles County
  • 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. Peters page.

Common questions

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

In many cases, yes. Gateway arranges home visits with partner clinicians for people in St. Peters 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.

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.

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.

Is all of the 63376 ZIP code in St. Peters part of Gateway’s area?

Gateway coordinates care across St. Peters and the surrounding parts of St. Charles County, which includes the 63376 ZIP code. Because availability is confirmed by location and care setting, the surest way to know is to call 314-325-0126 with the street address. We will tell you plainly what can be arranged there.

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.