Understanding wounds with lymphedema

Over weeks and months, a lymphedema wound tends to follow the swelling. When the limb is well controlled, drainage usually slows, the edges firm up and the open area gets smaller. When compression lapses, an infection sets in or the person spends long days sitting, the limb fills again and the wound can stall or reopen.

Because of this, progress is rarely a straight line. Setbacks are common and do not mean the plan has failed, but they should be reported. In time, the goal shifts from closing the wound to keeping the skin intact, with garments and skin care that continue for the long term. The treating clinician sets expectations for your situation. No one can promise a timeline.

How the care plan is built

Compression is the main tool for reducing lymphedema, but it is not right for every limb on every day. Before ordering it, the treating clinician checks blood flow to the foot or hand, sometimes with a simple circulation test, because squeezing a limb with poor arterial supply can do harm. Heart and kidney conditions are reviewed, since moving fluid out of the legs places extra load on the heart. Loss of feeling in the feet also matters. A person who cannot feel a wrap digging in cannot report it.

With that information the clinician decides whether to use compression, what kind, and how firm. The decision is revisited as the limb changes.

Wound care with lymphedema in Downtown St. Louis

In Downtown St. Louis, many homes are apartments or older houses with the bedroom up a flight of stairs. Stairs are a real obstacle with a heavy, wrapped leg and bulky footwear, and some people end up sleeping in a chair downstairs with their legs hanging down, which makes swelling worse. A home visit lets the treating clinician see that setup and plan around it. When Gateway schedules the visit, we ask about buzzer entry, elevators and parking so the clinician can reach your door.

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

A home visit lets the treating clinician see the limb in the place where the swelling actually builds. The chair you spend the day in, the height of your bed and whether you have any way to prop up your legs all affect how much fluid collects. Those details are hard to describe in an office and easy to see in a living room.

It also spares you the trip. Moving a heavy, wrapped, draining leg into a car and through a waiting room is exhausting, and some people put off care because of it. Gateway arranges visits with partner clinicians in private homes, with availability confirmed by location.

Care in skilled nursing and assisted living

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.

Why primary care matters here

Lymph flow in the legs gets much of its push from the calf and foot muscles squeezing with each step, so anything that limits walking tends to worsen swelling. Primary care can look at what is holding a person back, whether that is joint pain, breathlessness, weakness or fear of falling, and whether therapy would help.

General health affects the wound as well. Healing draws on protein and calories, high blood sugar slows repair and raises infection risk, and extra body weight adds pressure on lymph vessels in the groin and legs. These are long-term concerns that a primary care clinician follows alongside the wound visits.

Primary care at home in Downtown St. Louis →

Arranging wound care with lymphedema in Downtown St. Louis

Setting up wound care with lymphedema for someone in Downtown St. Louis usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

The two hospitals people in Downtown St. Louis use most are SSM Health Saint Louis University Hospital, a couple of miles southwest on Grand Boulevard, and Barnes-Jewish Hospital in the Central West End. Gateway is not affiliated with either. If you are being discharged to a downtown apartment, ask your case manager to fax a referral, or call us yourself. Gateway requests the discharge records and wound orders, confirms building access, and arranges follow-up with a treating clinician. Discharge planners can help by noting the unit number and a contact who will answer the door.

  • 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 wounds with lymphedema, or see everything Gateway arranges on the mobile wound care in Downtown St. Louis page.

Common questions

Will Medicare or my health plan pay for lymphedema wound care in Downtown St. Louis?

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.

Could a compression pump help my lymphedema wound?

A pneumatic compression pump is a sleeve that inflates and deflates in sequence to move fluid out of a limb. Some people with lymphedema use one at home as part of a larger plan. It is not suitable for everyone, and concerns such as heart conditions, blood clots or active infection have to be considered first. The treating clinician decides. If one is ordered, Gateway coordinates the documentation and the equipment order.

Do I need a referral to request lymphedema wound care in Downtown St. Louis?

No. Patients, family members and caregivers can call Gateway directly at 314-325-0126 or send a callback request, with or without a referral. Some health plans have their own referral or authorization rules, and we ask about those when we confirm the treating provider. The web form asks only for a name and phone number, so please save medical details for the phone call.

I live in Downtown St. Louis without a car. Can wound care come to my apartment?

Yes, that is the purpose of the service. Gateway arranges for a partner clinician to see you in your apartment, so you do not need a ride for the visit itself. If the treating clinician orders a test or appointment that must happen elsewhere, we can help coordinate transportation arrangements. Availability for your building is confirmed when you call 314-325-0126.

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.