Wound care with lymphedema in Clayton and Central County.

About wounds with lymphedema

People whose swelling has been present for a long time are the ones most likely to develop a lymphedema wound. That includes people who had lymph nodes removed or treated with radiation for cancer, people with long-standing vein disease in the legs, and people who have had skin infections in the same limb more than once. Severe obesity can overload the lymphatic system. So can spending most of the day seated with the legs down, which is common after a stroke, with advanced arthritis, or with heart and lung conditions that limit walking.

A smaller group is born with lymph vessels that did not form normally, and their swelling may begin in childhood or early adulthood. Older adults often have several of these causes at once.

How the care plan is built

Lymphedema wound care is built in stages, and the plan is expected to change. Early on, the focus is on reducing the swelling and controlling drainage, and wraps may need frequent adjustment as the limb shrinks and they loosen. At each visit the treating clinician measures the wound, and often the limb itself, and compares the numbers with earlier visits.

When the limb size has settled, attention turns to maintenance. That may mean fitting a garment for daily wear and deciding whether a lymphedema therapist should be involved. If the measurements stop improving, the clinician looks again at the cause, the fit of the compression and what is happening between visits.

Local context: Clayton and Central County

Across Clayton and Central County, the person helping with lymphedema care is often a spouse of about the same age. Lifting a heavy leg and applying layered wraps may be more than that person can safely do, and the treating clinician takes this into account when writing orders. With senior living communities and skilled nursing facilities close by, people also move between home and rehabilitation. Gateway works to carry the compression and dressing orders across each move, so the routine does not have to be rebuilt each time.

You will find nearly every kind of home in Clayton and Central County: high-rise condos with a front desk, older brick apartment buildings without elevators, two-story houses, duplexes and bungalows in the inner suburbs. Senior living is well represented too, from independent apartments to assisted living, memory care and skilled nursing and rehabilitation. Gateway arranges partner clinician visits in each setting. We ask about elevators, entry and parking for apartment and condo visits, and we work with facility nurses on timing so a visit does not collide with therapy or meals.

At home between visits

Few people with lymphedema in the legs can manage the care alone. Reaching the feet, lifting a heavy limb and applying layers of wrap take flexibility and strength that the condition itself wears away. A spouse, an adult child or a paid caregiver often does the daily skin care, and the treating clinician may order home health nursing for dressing changes and compression.

Gateway shares the clinician’s orders with the home health agency and coordinates the schedule so everyone follows one plan. Caregivers are welcome at visits. It is the right time to ask what you are expected to do and what should be left to a nurse.

For residents of nursing and senior living communities

A resident with lymphedema usually has other conditions that the attending physician is managing, and several of them influence swelling. The treating wound clinician and the attending physician need the same information: what the wound looks like, what compression is in place, and whether fluid, weight or medicines have changed.

Gateway handles the paperwork side of that exchange. Visit findings and recommended orders go to the attending physician and the director of nursing, and relevant labs or notes from the facility come back to the wound clinician. Each clinician keeps authority over their own decisions, and the facility keeps one clear record.

Changes to report

Small changes in the skin of a limb with lymphedema are worth reporting early, while they are easier to deal with. Let the treating clinician know about:

• A wound that is getting larger or deeper
• A clear increase in leaking, or dressings that soak through faster than before
• New blisters, raw patches or cracks, especially in skin folds
• Skin around the wound that turns white, soggy or sore
• Itching, scaling or splits between the toes
• A new or stronger odor

Call 911 for heavy bleeding that does not stop with firm pressure, or if the person becomes confused or hard to wake.

Primary care and overall health

Because lymphedema lasts longer than any single wound, someone needs to hold the long view. A primary care clinician can track how often skin infections return, check the feet and toenails for the fungal problems that let bacteria in, and serve as the point of contact for the other specialists you see.

Gateway arranges wound care and primary care together for this reason. When the wound visits wind down, there is already a clinician who knows the history, the garments in use and what an early flare looks like for you. Questions such as who reorders garments, and how often the limb should be rechecked, have a place to go.

Primary care at home in Clayton and Central County →

Arranging wound care with lymphedema in Clayton and Central County

If you have been managing a wound mostly on your own and are looking for wound care with lymphedema in Clayton and Central County, 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.

For people in Clayton and Central County, the nearest hospital is usually SSM Health St. Mary’s Hospital in Richmond Heights. Many also go east to Barnes-Jewish Hospital or west to Missouri Baptist Medical Center in Town and Country. Gateway has no affiliation with these hospitals. A discharge planner can refer by fax, and a family member can call us while the patient is still admitted. We ask for the discharge summary and wound orders, verify the address the patient is returning to, and arrange follow-up with a treating clinician who directs wound care from that point.

• County: St. Louis County, Missouri
• ZIP codes: 63105, 63117, 63124
• Nearby hospitals: SSM Health St. Mary's Hospital in Richmond Heights; Barnes-Jewish Hospital; Missouri Baptist Medical Center in Town and Country (not affiliated with Gateway)
• Nearby communities: Richmond Heights, University City, Ladue, Brentwood, Maplewood, Central West End
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

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

• Diabetic foot ulcers
• Venous leg ulcers
• Pressure injuries and bed sores
• Arterial and mixed wounds
• Non-healing wounds
• Post-surgical wounds
• Reopened (dehisced) surgical wounds
• Surgical site infections
• Skin tears and traumatic wounds
• Skin graft aftercare
• Wound VAC (NPWT) follow-up
• Wound care with lymphedema in University City
• Wound care with lymphedema in Ladue
• Wound care with lymphedema in the Central West End

Common questions