About wounds with lymphedema

Lymphedema is long-term swelling that builds when the lymphatic system cannot carry fluid out of an arm or leg as fast as it collects. The lymphatic system is a network of thin vessels and nodes that returns fluid to the bloodstream and helps the body fight infection. When it falls behind, fluid that is rich in protein settles in the tissue under the skin.

A lymphedema wound is any open area on a limb swollen this way. It may be a shallow raw patch, a blister that has burst, a split at the bottom of a skin fold or a deeper ulcer. Most are on the lower legs, ankles and feet. What they share is the setting: skin that is stretched, damp and slow to repair itself.

What the treating clinician looks at

The care plan for a lymphedema wound has to fit the person who will live with it. The treating clinician weighs practical questions alongside the clinical ones:

  • Can you reach your own feet, and do you have the hand strength to manage wraps or garments?
  • Who is available to help, and at what times of day?
  • Where do you rest, and can the limb be raised there?
  • What will you wear on your feet over the wraps?

The answers shape the orders. A plan built on a garment that nobody in the house can put on will not last. Gateway then coordinates the supplies, any home health involvement and the follow-up schedule the clinician sets.

Arranging this care in the Central West End

Large medical centers, cancer programs and lymphedema therapy clinics are often a short distance from the Central West End. Getting to them is another matter when a leg is leaking through its dressing. Parking garages, long corridors and waiting rooms can mean an hour or more with the limb down. Gateway arranges wound visits where you live and coordinates records with the specialists you already see. Tell us how package delivery works in your building, so boxes of absorbent dressings and wrap supplies reach you and not just the lobby.

Housing in the Central West End stacks up as much as it spreads out. There are doorman towers along Lindell Boulevard and Kingshighway, brick walk-ups and converted mansions on the side streets, newer apartment buildings near the medical campus, and senior apartments, assisted living and skilled nursing within the neighborhood or a short distance away. Gateway arranges partner clinician visits in all of them. For secured buildings we ask ahead about the front desk, entry codes and visitor parking. For facilities we coordinate with the nursing team on timing and orders.

Care at home

Most of the work on a lymphedema wound happens between visits. The treating clinician leaves instructions for the days in between, and they usually cover washing and thoroughly drying the skin, using a moisturizer if one is ordered, keeping wraps or garments on as directed and resting with the limb raised.

Wraps slip, dressings soak through and questions come up. Ask at the visit whom to call when that happens and what to do in the meantime, so no one is left guessing on a weekend. If part of the routine is not working, say so. A plan can be adjusted, but only if the clinician hears about the problem.

Care in skilled nursing and assisted living

In a skilled nursing facility, a lymphedema plan succeeds or fails on consistency. A wrap put on firmly by the day shift and loosely by the evening shift does not control swelling, and gaps of a day or two let the limb refill. The treating clinician writes orders that are specific about the dressing, the compression and how often each is changed, and reviews them with the nurses who will carry them out.

Gateway coordinates the visit schedule with the facility and sends the orders and visit notes to the nursing team. Staff questions that come up between visits go back to the clinician.

Changes to report

Changes in the swelling itself can point to something beyond the wound. Tell the treating clinician about:

  • Swelling that increases quickly over a day or two
  • Swelling that moves higher, into the thigh, groin or belly
  • Rapid weight gain, or shoes and garments that suddenly do not fit
  • Needing extra pillows to breathe comfortably at night

Sudden swelling and pain in one leg, often with warmth in the calf, needs urgent medical evaluation because it may be a blood clot. Call 911 for chest pain, trouble breathing, coughing up blood, fainting, or a racing heartbeat with lightheadedness.

Why primary care matters here

Medicines are part of the swelling picture. Some commonly prescribed drugs, including certain blood pressure, diabetes, pain and hormone medicines, can cause the legs to hold fluid. Water pills reduce some kinds of swelling and do little for others, and they can affect the kidneys and blood pressure along the way.

Sorting this out is a job for the prescriber. Do not stop or change a medicine on your own because of swelling. A primary care visit that includes a full medication review gives the prescriber and the wound clinician a shared, current list, and Gateway coordinates the records so both are working from it.

Primary care at home in the Central West End →

Arranging wound care with lymphedema in the Central West End

To arrange wound care with lymphedema in the Central West End, 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.

Barnes-Jewish Hospital is in the neighborhood itself. SSM Health Saint Louis University Hospital is a short drive southeast on Grand Boulevard, and SSM Health St. Mary’s Hospital in Richmond Heights is just west of Forest Park. Gateway is independent of all three. When a patient from the Central West End is discharged, the case manager can fax a referral, or the family can call. We request the discharge records, confirm the home or facility address, and arrange follow-up with a treating clinician, so wound care continues after the hospital’s part ends.

Related care in the Central West End

Read the full guide to wounds with lymphedema, or see everything Gateway arranges on the mobile wound care in the Central West End page.

Common questions

Will Medicare or my health plan pay for lymphedema wound care in the Central West End?

It depends. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Whether a provider participates, and what your benefits are, depends on the treating provider, your plan and the care the clinician orders. Visits, dressings, compression garments and pumps are often handled under different rules. We go over these questions with you before care starts.

Why do I keep getting cellulitis in the same leg?

A limb with lymphedema clears bacteria slowly, so germs that get in through a crack, a blister or peeling skin between the toes can take hold quickly. Each infection can scar more lymph vessels, which adds swelling and sets up the next one. Tell your clinicians how often it has happened. They can look for the entry points and decide what prevention makes sense for you.

Can Gateway arrange lymphedema wound care in a nursing home or assisted living community in the Central West End?

Yes, we arrange visits in skilled nursing, assisted living, memory care and rehabilitation settings, subject to availability for that location. A facility nurse, social worker or attending physician can refer, and so can a family member. The treating clinician coordinates with facility staff on dressing changes and compression, and Gateway handles scheduling and paperwork between the facility and the clinician.

Can a clinician visit a high-rise or secured building in the Central West End?

Yes. Tell us the building name, the unit number and how guests are admitted, whether through a front desk, a call box or a code. If the building needs advance notice or a name at the desk, we pass that to the visiting clinician. Mention any guest parking or the closest side street. Details like these are a normal part of planning a visit in the Central West End.

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.