Understanding non-healing wounds

A stalled wound rarely stays exactly the same. Over weeks and months it tends to drift. It may look a little better for a stretch, then worse after a swollen week, a fall or a few missed dressing changes. Drainage rises and falls. The skin around it may turn soggy and pale from moisture, or dry, hard and callused at the rim.

The longer a wound stays open, the more its edges and base can change in ways that make closing harder, and the more opportunity bacteria have to settle in. That is why clinicians record size, depth and tissue appearance at each visit and compare them over time. A single snapshot says little. A month of measurements shows whether the plan is working or needs to change.

What an assessment covers

Part of building the plan is agreeing on the goal. For most people the goal is full closure, and the plan is aimed at removing whatever stands in the way. For some, especially people who are very frail or whose circulation cannot be improved, the treating clinician may talk with the patient and family about a different aim: keeping the wound stable, clean, comfortable and free of infection.

Either way, the clinician explains what they found, what they think is holding the wound back and what they recommend. You should come away knowing what the plan is, who does what, and how you will be able to tell whether it is working.

Local context: Alton and the Riverbend

Many people in the Riverbend have crossed the river for years to see a vascular surgeon, podiatrist or wound clinic in St. Louis, while their primary care, pharmacy and home health agency are in Illinois. With a stalled wound, that split can leave no one holding the full picture. Gateway collects notes from both states and gets them to the treating clinician. If a test or specialty visit is ordered, we ask whether your plan requires an Illinois location or a referral before anything is booked. Coverage depends on your plan and the treating provider.

The Riverbend is the name people give to the cluster of Illinois towns where the Mississippi swings east near its meeting with the Missouri: Alton, Godfrey, East Alton, Wood River, Bethalto, Roxana and Hartford. They share a river, a long history of industrial work and a set of state highways. They differ a great deal on the ground, from bluff-top neighborhoods to flat blocks of small houses to open country north of Godfrey. In every one of them, people who cannot travel easily still need wound care and regular medical follow-up, and that is the part Gateway arranges.

At home between visits

Most of the work on a slow wound happens between visits. Dressings are changed on the schedule the clinician ordered, by the patient, a family member or a visiting nurse. Someone keeps an eye on the drainage and the skin around the wound. Leg elevation, pressure relief or wraps are kept up day after day.

Gateway helps keep that routine from breaking down. We ask whether the dressing is manageable, relay questions to the treating clinician and schedule the next visit. If something changes, such as a hospital stay or a new caregiver, tell us so the plan and the visit schedule can be revisited.

Care in skilled nursing and assisted living

People arrive at a rehabilitation center after surgery, a fracture or a long illness, and some bring a wound that was already slow before the hospital stay. Rehab adds its own pressures: therapy sessions, new braces or footwear, more hours sitting up, and a discharge date approaching.

A partner clinician can reassess the wound during the stay and coordinate with the therapy and nursing teams, for example on how a brace sits near the wound. Because the stay is short, Gateway also plans the handoff: where the patient is going next, who will change dressings there, and how follow-up visits will continue after discharge.

What to report and when to call 911

A wound that has been open a long time can still change quickly, and it is easy to stop noticing it. Tell the treating clinician if you see:

  • Redness spreading outward from the wound edge
  • Drainage soaking through dressings faster than before
  • A new or stronger smell after the wound is cleaned
  • Skin around the wound turning warm, hard or shiny
  • Pain that is climbing instead of settling

Call 911 for heavy bleeding that does not stop with firm pressure, chest pain, trouble breathing, or new confusion with a high fever or shaking chills. Gateway is not an emergency service.

Primary care and overall health

Some people with a long-standing wound have not seen a primary care clinician in a long while. Getting to an office may be the obstacle: stairs, a wheelchair, no ride, or a wound that leaks through its dressing on the way. Meanwhile blood pressure, weight, mood, sleep, tobacco use and mobility go unreviewed, and each has a hand in how skin repairs.

Gateway can arrange primary care in the same settings as wound care, including at home. One coordinated plan means fewer conflicting instructions and one place to call with questions. Each clinician still makes the decisions in their own area.

Primary care at home in the Riverbend →

Arranging non-healing wound care in the Riverbend

Clinicians and facility staff referring a patient for non-healing wound care in the Riverbend can call 314-325-0126 or fax 314-786-7966. Helpful to include: demographics and insurance, the working diagnosis, recent wound notes and measurements, current orders, the medication list and relevant test results. Please also tell us who should receive the treating clinician’s notes afterward. The online referral form takes contact details only, so clinical records should come by fax, not through the form. Gateway confirms that the referral arrived, checks availability for the patient’s address and lets your office know what has been scheduled.

The two general hospitals in the Riverbend, Alton Memorial Hospital and OSF Saint Anthony’s Health Center, are both in Alton. Patients from Wood River, Bethalto and the other towns are commonly discharged from them, and Gateway has no affiliation with either. A discharge to a home a few towns away can leave a family unsure who checks the wound next. Families can call us with that question. Discharge planners can refer by phone at 314-325-0126 or fax at 314-786-7966, and we coordinate follow-up with a partner clinician and the regular doctor.

  • County: Madison County, Illinois
  • ZIP codes: 62002, 62035, 62024, 62095, 62010
  • Nearby hospitals: Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton (not affiliated with Gateway)
  • Nearby communities: Alton, Godfrey, Illinois, Edwardsville, Granite City
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in the Riverbend

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

Common questions

How do I start non-healing wound care in the Riverbend 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.

Will the clinician need to remove tissue from the wound, and does it hurt?

Removing dead or unhealthy tissue, called debridement, is common in chronic wound care because that tissue blocks repair and shelters bacteria. Whether it is needed, and by which method, is the treating clinician’s decision. Some methods are gentle and gradual. Others are done with instruments, with attention to comfort. Tell the clinician about your pain beforehand and ask what to expect.

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.

Which towns does Gateway include in the Riverbend?

Alton, Godfrey, East Alton, Wood River, Bethalto, Roxana and Hartford, the Madison County towns near the bend of the Mississippi. If you are not sure whether your address fits, call 314-325-0126 anyway. Gateway also arranges care in Edwardsville and Granite City, and availability is confirmed by address and care setting, not by the name of the town.

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.