What to know about 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.
How the care plan is built
The treating clinician usually begins with the story before looking at the wound. When did it start, and from what? Has it ever closed? Which dressings, antibiotics, wraps or devices have been used, for how long, and what happened with each one? Old measurements and photos are especially useful, because they show direction.
With that timeline in hand, the clinician examines the wound and the limb or body area around it, then decides what is still unexplained. The care plan that follows is built around the likely cause, not around a product. It names what will change, who will do each part between visits, and when the wound will be measured again.
Arranging this care in Downtown St. Louis
In Downtown St. Louis, many people with a slow wound live in upper-floor apartments or tall older houses with steep stairs. Each trip down for an appointment puts weight on a foot ulcer or leaves a swollen leg hanging, and some people simply stop going. A reassessment at home removes that trip. Before the visit, Gateway asks about building entry, buzzer codes, elevators, parking and where supply deliveries can be left safely. The large medical centers nearby remain the place for vascular testing or specialty procedures when the treating clinician orders them.
Downtown St. Louis is the central business district beside the riverfront, stretching west from the Gateway Arch through Downtown West. Many of its former warehouses and office buildings along Washington Avenue and the nearby streets are now lofts and apartments, and people of every age live among the stadiums, hotels and courthouses. Living downtown often means living without a car, in a building with elevators, secured doors and a front desk. For a resident with a wound or a chronic illness, care that comes up to the apartment is far simpler than arranging a ride out.
When care happens at home
Many people with a long-standing wound already have a home health agency involved. When that is the case, the partner clinician and the agency nurses work from the same orders. The nurses carry out dressing changes and report measurements, and the clinician adjusts the plan at each visit. Gateway shares visit notes with the agency so both sides see the same picture.
Supplies are the other piece. Running out of the ordered dressing and substituting whatever is in the cabinet is a common way for wounds to slip backward. We help route supply orders through the proper channel and ask about quantities before they run low.
In a facility
In a skilled nursing facility, a wound that has not improved is a shared concern for the nurses, the attending physician, the family and often the facility’s own wound nurse. A partner clinician arranged through Gateway sees the resident at the bedside, reviews the treatment record and weekly measurements, and talks with the nurse who knows the wound.
Recommendations and orders go through the facility’s normal process, with the attending physician kept informed. Floor staff continue the daily dressing changes and turning schedule. Gateway coordinates visit days with the facility and sends documentation back for the chart.
Signs to tell the clinician about
Not every change is an emergency, but these deserve a prompt call to the treating clinician’s office:
- Red streaks running up the arm or leg from the wound
- Pus, or drainage that turns green, tan or cloudy
- Home blood sugar readings well above your usual range
- Numbness, tingling or new swelling below the wound
- A wound that had closed and has opened again
If you cannot reach the office and you are worried, go to urgent care or an emergency department. Call 911 right away for spurting or uncontrolled bleeding, chest pain or pressure, difficulty breathing, or a limb that suddenly turns cold and discolored.
How primary care fits in
Two questions come up with nearly every stalled wound: what is this person eating, and what are they taking? Repair needs protein, calories, fluids and certain vitamins, and many older adults with wounds eat far less than they need. Some medicines, including steroids and drugs that act on the immune system, can slow repair as well.
Neither issue should be handled alone. Do not stop or change a medicine by yourself. A primary care clinician can review the full list with the wound in mind, check weight and labs, and weigh the tradeoffs. Arranging primary care alongside wound care makes that review far more likely to happen.
Arranging non-healing wound care in Downtown St. Louis
For a resident of a nursing home, assisted living or memory care community in Downtown St. Louis, a request for non-healing wound care can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.
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
Other conditions and nearby communities
Read the full guide to non-healing 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
- Arterial and mixed 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
- Non-healing wound care in the City of St. Louis
- Non-healing wound care in the Central West End
- Non-healing wound care in North St. Louis
- Non-healing wound care in South St. Louis
Common questions
Can a clinician come to a home in Downtown St. Louis to look at a wound that will not heal?
In many cases, yes. Gateway arranges home visits with partner clinicians across Greater St. Louis and the Metro East, and we confirm availability for your exact address and care setting before scheduling. Call 314-325-0126 or send a request with a name and phone number. You do not need a referral to ask, and a family member can call for you.
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.
Who changes the dressing between visits?
It depends on the plan and the help available. Some people manage their own dressings, some rely on a spouse or adult child, and some have a home health nurse or facility nurse. The treating clinician writes the orders with that person in mind. If nobody is able to do the changes as ordered, say so, and the clinician can look at other options.
How does a visiting clinician get into a secured loft building in Downtown St. Louis?
The same way any invited guest does, with a little planning. Tell us whether your building uses a call box, a key fob, a front desk or a manager who lets visitors in. We give those instructions to the clinician before the visit. If you cannot come down to the door yourself, let us know who can, or ask your building office whether it will admit a scheduled medical visitor.
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.