About arterial and mixed wounds
Several common beliefs about leg wounds do not hold for arterial and mixed wounds. One is that every leg sore should be wrapped tightly, when firm wrapping on a leg with poor arterial flow can do harm. Another is that propping the feet up always helps. With artery disease, raising the legs can make pain worse, so the right position is something to ask the clinician about.
People also assume that a small, dry wound is a minor one, or that foot pain at night is just age or arthritis. And many expect the right dressing to fix the problem, when the blood supply usually matters more than anything placed on the wound.
What the treating clinician looks at
Mixed wounds ask the treating clinician to balance two problems that pull in opposite directions. Vein disease calls for controlling swelling, usually with compression. Artery disease limits how much squeeze the leg can safely take. The clinician weighs the circulation results, the amount of swelling and drainage, and how the leg feels to the patient, then decides whether compression is appropriate and in what form.
The plan also covers care for the fragile, often discolored skin of the lower leg and dressings that can handle drainage. Orders are revisited as the leg changes, particularly after any vascular procedure.
Local context: Downtown St. Louis
In Downtown St. Louis, the building itself is part of the care plan. A third-floor walk-up is hard on anyone whose calves cramp after a short distance, and each trip down the stairs for an appointment risks a bumped toe or shin. Care brought to the apartment avoids that. When Gateway schedules a visit, we ask about entry codes, buzzers, elevators and where a visiting clinician can park, so the time goes to the wound. For vascular testing at a nearby medical center, we help arrange transportation suited to someone who cannot walk far.
Homes in Downtown St. Louis are almost all multi-unit: converted lofts, high-rise apartment towers, senior apartment buildings and a smaller number of condominiums. Skilled nursing and rehabilitation centers lie a short distance away in neighboring parts of the city. Gateway arranges partner clinician visits to all of these settings. Before a downtown visit we confirm how to get past the front door, whether a building manager needs notice, and where the clinician can leave a car. We also ask where supply deliveries should go, since packages are handled differently in each building.
When care happens at home
Family caregivers are often the first to notice trouble with an arterial wound, because they see the foot every day. The treating clinician can show a spouse, adult child or paid aide what the wound should look like, how the dressing is handled under the current orders, and which changes call for a phone call.
Caregivers also help in quieter ways: checking that socks and shoes are not leaving marks, keeping walkways clear so toes are not stubbed, and making sure bedding is not pressing on sore toes at night. Gateway can include a caregiver on scheduling calls and updates when the patient agrees.
In a facility
In a skilled nursing facility, partner clinicians see residents with arterial or mixed wounds on site and write recommendations for the attending physician and nursing staff. Facility nurses carry out the daily dressing orders and are well placed to catch change early, since they see the foot every shift.
Gateway coordinates the visit schedule with the director of nursing or wound nurse, sends visit notes for the chart, and tracks open items such as a pending circulation test. Clear documentation of whether compression is ordered for each leg matters here, because staff rotate and a routine wrap on the wrong leg is an avoidable error.
Signs to tell the clinician about
Arterial wounds can change quietly, so small differences are worth a call. Contact the treating clinician’s team promptly if you notice:
- Pain that is stronger, or that now wakes you at night
- A toe or patch of skin turning dusky, purple or black
- The wound getting wider or deeper
- New drainage or odor, or a dry scab turning soft
- Redness or warmth spreading out from the wound
Call 911 if a foot or leg suddenly turns cold, pale or blue, goes numb, or becomes severely painful or hard to move. A sudden loss of blood flow is an emergency.
How primary care fits in
Peripheral artery disease is rarely limited to the legs. The same buildup that narrows a leg artery often affects the vessels of the heart and brain, which is why a foot wound from poor circulation leads clinicians to look at the whole person.
A primary care clinician manages blood pressure, cholesterol and diabetes, and reviews the medications prescribed to protect the heart and blood vessels. Gateway can arrange primary care alongside wound care, so the clinician dressing the wound and the clinician managing overall health share records and each knows what the other has ordered.
Getting care arranged in Downtown St. Louis
Before anything is scheduled, Gateway checks two things for every request for arterial and mixed wound care in Downtown St. Louis: whether a partner clinician serves that address and care setting, and what the patient’s plan requires from the treating provider. Neither is assumed. If both line up, we arrange the visit and gather records. If something stands in the way, we say so, and our guide to following up on a request explains what to ask next. Gateway coordinates the care and does not make clinical decisions. Those belong to the treating clinician who sees the wound. Start by calling 314-325-0126, or ask a family member to call for you.
Three things make a request for care in Downtown St. Louis go smoothly. First, the full address with unit number and ZIP code, whether 63101, 63102 or 63103. Second, access details: call box name, door code, front desk hours, guest parking or the nearest garage. Third, a phone that will be answered when the clinician arrives. Ball games, concerts and street closures can affect timing, so we plan around them where we can. Gateway also arranges care in the Central West End, North St. Louis, South St. Louis and across St. Louis City.
- County: City of St. Louis, Missouri (an independent city)
- ZIP codes: 63101, 63102, 63103
- Nearby hospitals: SSM Health Saint Louis University Hospital; Barnes-Jewish Hospital (not affiliated with Gateway)
- Nearby communities: St. Louis City, Central West End, North St. Louis, South St. Louis
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
Related care in Downtown St. Louis
Read the full guide to arterial and mixed wounds, or see everything Gateway arranges on the mobile wound care in Downtown St. Louis page.
- Diabetic foot ulcers
- Venous leg ulcers
- Pressure injuries and bed sores
- Non-healing wounds
- Post-surgical wounds
- Reopened (dehisced) surgical wounds
- Surgical site infections
- Skin tears and traumatic wounds
- Wounds with lymphedema
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Arterial and mixed wound care in the City of St. Louis
- Arterial and mixed wound care in the Central West End
- Arterial and mixed wound care in North St. Louis
- Arterial and mixed wound care in South St. Louis
Common questions
Do I need a referral to ask about arterial wound care in Downtown St. Louis?
No. Patients, family members and caregivers in Downtown St. Louis can contact Gateway directly, and hospitals, facilities and physician offices can refer as well. Some health plans do require a referral or authorization before certain visits or tests, and the treating clinician may need earlier records. We explain what is needed for your situation after the first call, before a visit is scheduled.
Why should I be careful with a heating pad or warm soak when my feet feel cold?
Feet with poor circulation often have reduced feeling as well, and skin that cannot sense heat or carry it away can burn at temperatures that seem mild. A burn on a poorly supplied foot becomes another wound to manage. Clinicians commonly suggest loose warm socks and blankets instead, and advise against soaking a foot with an open wound unless they have ordered it. Ask the treating clinician before using direct heat.
What should I have ready before the first visit for an arterial or mixed wound?
Helpful items include a current medication list, the names of your primary care clinician and any vascular or heart specialists, and results of past circulation tests or leg procedures if you have them. Set out the shoes and slippers you wear most. Write down when the wound started and when pain is worst. Gateway can request outside records for the treating clinician, so missing paperwork is no reason to delay calling.
Can staff at a senior apartment building in Downtown St. Louis contact Gateway for a resident?
Yes, with the resident’s agreement. Service coordinators, building managers and social workers in Downtown St. Louis can call us to start a request or help a resident make the call. We need the resident’s name and phone number to begin. Medical details should be shared by phone, not through the web form. The resident chooses who Gateway may talk to about scheduling and care.
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.