About non-healing wounds

Anyone can have a wound that stalls, but some people are more likely to. Older adults are seen most often, because skin thins with age and repair slows. People living with diabetes, vein disease, narrowed leg arteries, heart failure or kidney disease are also common, since each condition affects blood flow, swelling or the body’s ability to rebuild tissue.

Limited mobility raises the odds too. Someone who spends most of the day in a wheelchair, recliner or bed puts steady pressure on the same areas. People who have lost feeling in their feet may not notice a shoe rubbing until the skin has broken. People who smoke, people recovering from a long hospital stay and people who are eating very little also turn up often with wounds that will not close.

How the care plan is built

A care plan for a stalled wound usually has several parts working together, because one change alone is seldom enough. The treating clinician may decide on some combination of:

  • Clearing unhealthy tissue so the wound bed can rebuild
  • A dressing matched to how much the wound drains
  • Taking weight or friction off the area
  • Controlling swelling in the limb
  • Referral to a vascular, surgical, dermatology or infectious disease specialist

Each part is assigned to someone: the clinician, a nurse, a caregiver or the patient. The plan also sets a point at which progress will be judged and the approach reconsidered if the wound has not responded.

Arranging this care in Affton

Many households in Affton have been in the same home for decades, and the house has not changed as its owner has. A bedroom upstairs can mean sleeping in a recliner, which keeps the legs down all night and pressure on the tailbone. An old tub makes washing a leg wound awkward. The partner clinician sees these things on a home visit and can account for them in the plan. Gateway also asks about long-used favorites, such as a flattened seat cushion or tight house shoes, that may be working against the wound.

Affton sits just southwest of the St. Louis city limits, an unincorporated South County community that grew up along Gravois Road and Mackenzie Road. Blocks of brick bungalows and modest ranch houses fill the streets between them, and many households have been in the same home for decades. That staying power is the reason care at home matters here. When a wound needs regular attention or a chronic condition needs follow-up, a visit to the house or to a nearby facility spares an older adult the drive, the parking lot and the waiting room.

At home between visits

Many people with a long-standing wound already have a home health agency involved. When that is the case, the partner clinician and the agency nurses work from the same orders. The nurses carry out dressing changes and report measurements, and the clinician adjusts the plan at each visit. Gateway shares visit notes with the agency so both sides see the same picture.

Supplies are the other piece. Running out of the ordered dressing and substituting whatever is in the cabinet is a common way for wounds to slip backward. We help route supply orders through the proper channel and ask about quantities before they run low.

In a facility

For a resident in memory care, a wound that will not heal often has a behavioral side. The person may pull off dressings, scratch at the area, pace for hours on swollen legs, or be unable to say that something hurts. Staff who know the resident usually know these patterns well.

The treating clinician takes that knowledge into account when choosing dressings and how they are secured, and may suggest timing care for the calmest part of the resident’s day. A familiar staff member or relative at the visit helps. Gateway arranges those details ahead of time and updates the family or legal decision-maker afterward.

Changes to report

If you care for someone who cannot describe how they feel, you are the early warning. Let the treating clinician know about:

  • Guarding, flinching or crying out when the area is touched
  • Less interest in eating or drinking
  • New restlessness, sleepiness or confusion
  • A swollen limb, especially on one side only
  • Stains on bedding or clothing from drainage or blood

Write down the date you first noticed the change and mention it when you call. Do not wait on an emergency. Call 911 for bleeding you cannot control, fainting, a seizure, severe shortness of breath or sudden weakness on one side of the body.

Primary care and overall health

Two questions come up with nearly every stalled wound: what is this person eating, and what are they taking? Repair needs protein, calories, fluids and certain vitamins, and many older adults with wounds eat far less than they need. Some medicines, including steroids and drugs that act on the immune system, can slow repair as well.

Neither issue should be handled alone. Do not stop or change a medicine by yourself. A primary care clinician can review the full list with the wound in mind, check weight and labs, and weigh the tradeoffs. Arranging primary care alongside wound care makes that review far more likely to happen.

Primary care at home in Affton →

How to get started in Affton

To arrange non-healing wound care in Affton, 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.

People in Affton are most often hospitalized at Mercy Hospital South, SSM Health St. Mary’s Hospital in Richmond Heights or St. Luke’s Des Peres Hospital. Gateway is not affiliated with any of them, but follow-up after a stay at any of the three can be arranged through us. A family member can call once a going-home date is known, and a discharge planner or case manager can send a referral by fax. We gather the discharge summary and wound orders, confirm the address in 63123, and arrange a visit with a treating clinician who directs wound care from there.

  • County: St. Louis County, Missouri
  • ZIP codes: 63123
  • Nearby hospitals: Mercy Hospital South; SSM Health St. Mary's Hospital in Richmond Heights; St. Luke's Des Peres Hospital (not affiliated with Gateway)
  • Nearby communities: Mehlville, South County, Webster Groves, Crestwood, South St. Louis, Shrewsbury
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Affton

Read the full guide to non-healing wounds, or see everything Gateway arranges on the mobile wound care in Affton page.

Common questions

How do I start non-healing wound care in Affton if I do not have a referral?

Call 314-325-0126 or use the request form, which asks only for a name and phone number. Please leave medical details out of the form. We call back, ask about the wound, your location and the care setting, and confirm whether a partner clinician is available. With your permission we then request earlier records so the first visit is well informed.

What are advanced wound treatments, and will my wound need one?

Advanced therapies include options such as negative pressure devices, skin substitutes and specialized dressings. They are usually considered only after the basics are in place: the cause identified, pressure and swelling controlled, unhealthy tissue cleared and infection addressed. A stalled wound may begin to improve once those basics are corrected. The treating clinician decides whether an advanced option is appropriate, and health plans often have their own requirements.

My wound has been treated for months. What would a new clinician do differently?

A reassessment goes back to the cause instead of continuing the same routine. The treating clinician reviews the history, remeasures the wound and looks for barriers that may have been missed, such as pressure, swelling, poor blood flow or a hidden infection. They may order tests or suggest a specialist. Sometimes the plan changes a great deal, and sometimes only one piece does.

Is Affton part of the area Gateway serves, or does Gateway only work in St. Louis City?

Affton is part of the area. Gateway arranges care across Greater St. Louis, including unincorporated South County communities like Affton and the surrounding 63123 ZIP code. Because Affton has no city government of its own, mailing addresses usually read St. Louis, so give us the street address and ZIP when you call. Visit availability is confirmed for that location and care setting.

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.