About wounds with lymphedema

Lymphedema is long-term swelling that builds when the lymphatic system cannot carry fluid out of an arm or leg as fast as it collects. The lymphatic system is a network of thin vessels and nodes that returns fluid to the bloodstream and helps the body fight infection. When it falls behind, fluid that is rich in protein settles in the tissue under the skin.

A lymphedema wound is any open area on a limb swollen this way. It may be a shallow raw patch, a blister that has burst, a split at the bottom of a skin fold or a deeper ulcer. Most are on the lower legs, ankles and feet. What they share is the setting: skin that is stretched, damp and slow to repair itself.

What the treating clinician looks at

The care plan for a lymphedema wound has to fit the person who will live with it. The treating clinician weighs practical questions alongside the clinical ones:

  • Can you reach your own feet, and do you have the hand strength to manage wraps or garments?
  • Who is available to help, and at what times of day?
  • Where do you rest, and can the limb be raised there?
  • What will you wear on your feet over the wraps?

The answers shape the orders. A plan built on a garment that nobody in the house can put on will not last. Gateway then coordinates the supplies, any home health involvement and the follow-up schedule the clinician sets.

Arranging this care in Ferguson

Many people in Ferguson have lived in the same house for decades and have managed swollen legs on their own for nearly as long, often with worn stockings and a routine that worked until the skin opened. Older homes add their own difficulties: a tub to step over when legs need washing, a bathroom up the stairs, a favorite chair with no way to raise the feet. A treating clinician visiting at home can see these and suggest workable changes. Gateway coordinates the visit and any garments or supplies ordered.

In Ferguson you will see older frame and brick houses near the center of town, ranch homes in later subdivisions, and apartment complexes along the busier roads. Some households have three generations under one roof, and some older adults live alone. Skilled nursing, rehabilitation and assisted living facilities serve Ferguson and the neighboring cities. Gateway arranges partner clinician visits in homes, apartments and facilities alike. We ask who helps the patient day to day, because the treating clinician’s instructions need to reach that person, whether a daughter, a home aide or a charge nurse.

At home between visits

Supplies run out quickly when a lymphedema wound is draining. Absorbent dressings, padding and wrap materials may be changed several times a week, and going without them for even a day or two can set the limb back. Gateway coordinates supply orders with the treating clinician’s orders and follows up with the supplier on delivery to your home.

Tell us when you are getting low, well before the last box is opened. It also helps to mention practical problems, such as fluid soaking through to bedding or furniture, or dressings that will not stay in place overnight. The clinician can often change the dressing or the plan to deal with them.

In a facility

Rehabilitation stays are hard on swollen legs. Long sessions in a wheelchair with the feet down let fluid pool, and wraps can loosen or slide during therapy. The treating clinician works with physical and occupational therapists on timing and positioning, such as when wraps are checked, how leg rests are used and how much ankle movement and walking can be built into the day.

Discharge needs planning too. Before the resident goes home, someone has to know who will apply compression, where supplies will come from and who follows the wound. Gateway can arrange for visits to continue at home, with availability confirmed by location.

Changes to report

Changes in the swelling itself can point to something beyond the wound. Tell the treating clinician about:

  • Swelling that increases quickly over a day or two
  • Swelling that moves higher, into the thigh, groin or belly
  • Rapid weight gain, or shoes and garments that suddenly do not fit
  • Needing extra pillows to breathe comfortably at night

Sudden swelling and pain in one leg, often with warmth in the calf, needs urgent medical evaluation because it may be a blood clot. Call 911 for chest pain, trouble breathing, coughing up blood, fainting, or a racing heartbeat with lightheadedness.

Primary care and overall health

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 Ferguson →

How to get started in Ferguson

For a resident of a nursing home, assisted living or memory care community in Ferguson, a request for wound care with lymphedema 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.

Christian Hospital in North County and SSM Health DePaul Hospital in Bridgeton are where people from Ferguson are most often admitted. Neither is affiliated with Gateway. The step from hospital to home is where wound care tends to get lost: new dressings, new medications, and no one assigned to look at the wound next week. A discharge planner can prevent that by faxing a referral before the patient leaves. Families can call us with the same information. Gateway obtains the records and arranges follow-up with a treating clinician at the Ferguson address.

  • County: St. Louis County, Missouri
  • ZIP codes: 63135
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Florissant, Hazelwood, North County, North St. Louis, Bridgeton
  • 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 Ferguson page.

Common questions

Will Medicare or my health plan pay for lymphedema wound care in Ferguson?

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.

Should I rest with my leg raised or try to keep moving?

Usually both have a place. Raising the limb while resting lets gravity help fluid drain, and walking or moving the ankles works the muscles that push lymph along. Long hours sitting still with the feet on the floor tend to make swelling worse. The right balance depends on your heart, your steadiness on your feet and your wound, so ask the treating clinician what is safe for you.

Why does the skin on my swollen leg look thick and bumpy?

When protein-rich lymph fluid sits in the tissue for months or years, the skin responds by thickening and hardening. It may form deep creases at the ankle or grow small wart-like bumps, especially on the feet and toes. These changes are a sign of long-standing lymphedema. They make skin harder to keep clean and more likely to crack, so point them out to the treating clinician.

Can I ask about Medicaid or a Medicare Advantage plan for care in Ferguson?

Yes, please ask. People in Ferguson can ask about Medicare, Medicare Advantage, Medicaid and commercial plans. Whether a visit or supply is a benefit under your plan depends on the treating provider, the specific plan and the care that is needed, so we cannot answer that for you in advance. Have the insurance card nearby when you call, and we will explain what the treating practice needs to check.

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.