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.

What the treating clinician looks at

A care plan for a stalled wound usually has several parts working together, because one change alone is seldom enough. The treating clinician may decide on some combination of:

  • Clearing unhealthy tissue so the wound bed can rebuild
  • A dressing matched to how much the wound drains
  • Taking weight or friction off the area
  • Controlling swelling in the limb
  • Referral to a vascular, surgical, dermatology or infectious disease specialist

Each part is assigned to someone: the clinician, a nurse, a caregiver or the patient. The plan also sets a point at which progress will be judged and the approach reconsidered if the wound has not responded.

Local context: Madison County, Illinois

Many people in Madison County have crossed the river for years to see a vascular surgeon, podiatrist or wound clinic in St. Louis, while their primary care, pharmacy and home health agency are in Illinois. With a stalled wound, that split can leave no one holding the full picture. Gateway collects notes from both states and gets them to the treating clinician. If a test or specialty visit is ordered, we ask whether your plan requires an Illinois location or a referral before anything is booked. Coverage depends on your plan and the treating provider.

Madison County reaches from the Mississippi River at Alton and Granite City, over the bluffs to Edwardsville, Glen Carbon, Maryville and Collinsville, and east through farmland to Troy and Highland. Godfrey, Wood River and Bethalto fill in the north. That is a lot of ground, and the distance to a wound clinic or a doctor’s office varies widely from one town to the next. People who cannot travel easily, whether they live in a river-town bungalow or on a rural road, gain the most when care is arranged where they live.

When care happens at home

A home visit lets the treating clinician see things an exam room hides. The recliner where someone sleeps every night, the slippers worn all day, the step into the shower, the bandage supplies in a kitchen drawer: each can explain why a wound keeps stalling. The clinician assesses the wound at the bedside or in a favorite chair and writes orders based on what is realistic in that house.

Gateway schedules the visit, confirms who will be there and passes along records beforehand. Afterward we follow up on the orders so the plan does not sit on paper.

Care in skilled nursing and assisted living

Assisted living communities are not set up like nursing homes. Staff may help with medications and bathing but are often limited in the wound care they can provide, so a resident with a stalled wound can fall between services. Dressing changes may depend on a visiting home health nurse, a family member or the resident.

Gateway helps sort out who is doing what. We arrange the partner clinician’s visit to the resident’s apartment, find out what the community’s staff can assist with, and coordinate with any home health agency involved. The resulting plan is written for the help that is really available.

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.

Primary care and overall health

Blood sugar is one of the strongest links between general health and a wound that will not close. When sugar runs high, the cells that fight infection and build new tissue work poorly, and small blood vessels deliver less. A wound clinician can choose the right dressing at every visit and still see little progress if diabetes control has slipped.

That is primary care territory: reviewing readings, lab results and the overall diabetes plan. When Gateway arranges both kinds of care, the wound findings reach the clinician managing the diabetes, and changes on that side are known to the wound care team.

Primary care at home in Madison County →

How to get started in Madison County

For a resident of a nursing home, assisted living or memory care community in Madison County, 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.

Madison County patients are discharged from several hospitals: Anderson Hospital in Maryville, Alton Memorial Hospital, OSF Saint Anthony’s Health Center in Alton, Gateway Regional Medical Center in Granite City and HSHS St. Joseph’s Hospital in Highland. Gateway Wound Care is not affiliated with any of them, and follow-up can be requested no matter where the stay took place. A family member or discharge planner tells us where the patient is headed, whether home or a facility. We then obtain the discharge orders and arrange a visit with a partner clinician once availability for that location is confirmed.

  • County: Madison County, Illinois
  • ZIP codes: 62025, 62034, 62234, 62040, 62002, 62035
  • Nearby hospitals: Anderson Hospital in Maryville; Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton; Gateway Regional Medical Center in Granite City; HSHS St. Joseph's Hospital in Highland (not affiliated with Gateway)
  • Nearby communities: Edwardsville, Glen Carbon, Collinsville, Granite City, Alton, Godfrey, Illinois
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Madison County

Read the full guide to non-healing wounds, or see everything Gateway arranges on the mobile wound care in Madison County page.

Common questions

How do I start non-healing wound care in Madison County if I do not have a referral?

Call 314-325-0126 or use the request form, which asks only for a name and phone number. Please leave medical details out of the form. We call back, ask about the wound, your location and the care setting, and confirm whether a partner clinician is available. With your permission we then request earlier records so the first visit is well informed.

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.

My wound has been treated for months. What would a new clinician do differently?

A reassessment goes back to the cause instead of continuing the same routine. The treating clinician reviews the history, remeasures the wound and looks for barriers that may have been missed, such as pressure, swelling, poor blood flow or a hidden infection. They may order tests or suggest a specialist. Sometimes the plan changes a great deal, and sometimes only one piece does.

Which Madison County towns does Gateway cover?

Gateway arranges care in Edwardsville, Glen Carbon, Collinsville, Granite City, Alton and Godfrey, and takes requests from other Madison County communities such as Maryville, Troy, Highland, Wood River and Bethalto. Availability is not identical everywhere. It is confirmed by location and care setting, so the simplest step is to call 314-325-0126 with the address and ask.

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.