Care for a reopened surgical wound in University City.

What to know about reopened surgical wounds

Any operation can end with a reopened incision, but some people carry more risk than others. Wounds tend to knit more slowly in people living with diabetes, poor circulation, kidney disease or a weakened immune system, and in people who smoke. Extra body weight puts more pull on an abdominal closure and leaves a thicker fatty layer, which has a limited blood supply. Older adults with thin skin, people who were eating poorly before surgery, and people taking steroids long term are also more likely to have trouble. So are those whose operation was an emergency, ran long, or went through an old scar. None of this means dehiscence is certain. It tells the care team whom to watch closely.

What an assessment covers

Looking after a reopened incision is shared work, and the treating clinician sorts out early who decides what. Typically:

• The surgeon decides anything about the operation itself, including whether the wound is closed again later
• The treating clinician decides dressings, visit frequency and bedside wound care
• Nurses or trained caregivers carry out dressing changes between visits

At follow-up visits the clinician rechecks the wound against the last measurements, removes unhealthy tissue if that is needed and suitable for the setting, and prepares an update for the surgical office. If the wound deepens, exposes deeper layers or stops improving, the clinician contacts the surgeon instead of waiting for the next routine appointment.

Arranging this care in University City

People in University City 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.

University City begins where the Delmar Loop meets the St. Louis city line and runs west toward Interstate 170. Delmar Boulevard and Olive Boulevard carry traffic through it, and Clayton, Olivette and Overland are next door. This inner-ring suburb is dense by St. Louis County standards, with houses set close together and some residents who do not drive. For an older adult in an upstairs flat, or a person recovering from surgery, the hard part of an appointment is often the stairs and the ride, not the visit itself. Care at home removes both.

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.

For residents of nursing and senior living communities

Assisted living communities differ in how much nursing care they can provide, and an open surgical wound can test those limits. Some have a nurse who can change a dressing daily. Others rely on a home health agency coming in. When a resident’s incision opens, Gateway asks the community what its staff can and cannot do, then arranges the treating clinician’s visits and any outside nursing around that answer. Aides who help with bathing and dressing need the basics from the clinician’s orders as well: how the dressing is protected during a shower, how to avoid pulling on the area during transfers, and whom to tell if it is soaked or loose.

What to report and when to call 911

Some changes come on gradually and some arrive in a moment. A pop or tearing feeling at the incision, followed by a gush of pink fluid, can mean deeper layers are separating, and the surgeon should hear about it right away. Also report:

• A bulge under or beside the incision when you cough or stand
• Drainage that soaks through a fresh dressing quickly
• Red streaks, or warmth that has moved beyond the dressing border
• Shaking chills or a raised temperature

Call 911 if the wound opens wide, if you can see tissue or organs coming through it, or if you are short of breath, faint or bleeding heavily.

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 University City →

Arranging care for a reopened surgical wound in University City

If you have been managing a wound mostly on your own and are looking for care for a reopened surgical wound in University City, 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 few things make a University City request go smoothly. Have the street address and unit number, a phone number that will be answered, the name of the regular doctor and any hospital paperwork. Tell us about stairs, locked entries and where a visitor can park. Gateway also coordinates care nearby in Clayton and Central County, Overland, the Central West End, Ladue and Creve Coeur. Availability is confirmed by location and care setting, so we will ask whether the patient is at home or in a facility.

• County: St. Louis County, Missouri
• ZIP codes: 63130
• Nearby hospitals: Barnes-Jewish Hospital; SSM Health St. Mary's Hospital in Richmond Heights; Mercy Hospital St. Louis in Creve Coeur (not affiliated with Gateway)
• Nearby communities: Clayton and Central County, Overland, Central West End, Ladue, Creve Coeur
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in University City

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

• Diabetic foot ulcers
• Venous leg ulcers
• Pressure injuries and bed sores
• Arterial and mixed wounds
• Non-healing wounds
• Post-surgical wounds
• Surgical site infections
• Skin tears and traumatic wounds
• Wounds with lymphedema
• Skin graft aftercare
• Wound VAC (NPWT) follow-up
• Care for a reopened surgical wound in Clayton and Central County
• Care for a reopened surgical wound in the Central West End
• Care for a reopened surgical wound in Ladue
• Care for a reopened surgical wound in Creve Coeur

Common questions