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

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.

Arranging this care in Ferguson

Many households in Ferguson have been in the same home for decades, and the house has not changed as its owner has. A bedroom upstairs can mean sleeping in a recliner, which keeps the legs down all night and pressure on the tailbone. An old tub makes washing a leg wound awkward. The partner clinician sees these things on a home visit and can account for them in the plan. Gateway also asks about long-used favorites, such as a flattened seat cushion or tight house shoes, that may be working against the wound.

Ferguson is a North County city of older, tree-shaded neighborhoods set between Interstate 270 to the north and Interstate 70 to the south. Florissant Road runs through its small downtown, and West Florissant Avenue carries traffic along the east side. Most streets are lined with modest houses, many owned by the same families for a generation or more. When someone in one of those homes develops a wound that will not close, or comes back from the hospital weaker than before, care delivered at home or in a nearby facility keeps treatment from depending on a ride.

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.

Care in skilled nursing and assisted living

People arrive at a rehabilitation center after surgery, a fracture or a long illness, and some bring a wound that was already slow before the hospital stay. Rehab adds its own pressures: therapy sessions, new braces or footwear, more hours sitting up, and a discharge date approaching.

A partner clinician can reassess the wound during the stay and coordinate with the therapy and nursing teams, for example on how a brace sits near the wound. Because the stay is short, Gateway also plans the handoff: where the patient is going next, who will change dressings there, and how follow-up visits will continue after discharge.

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.

Primary care at home in Ferguson →

How to get started in Ferguson

You may already have a surgeon, a wound clinic or a home health nurse and still want help with non-healing wound care closer to home in Ferguson. That is a fine reason to call 314-325-0126. Tell us who is treating the wound now and what is not working, whether that is the travel, the gaps between appointments or unclear instructions. Gateway does not replace your current clinicians. We can arrange for a partner clinician to see the wound where you live and, with your permission, share notes with the offices already involved so the plans agree.

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

More wound care in Ferguson

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

Common questions

How often will someone visit for a wound that is not healing in Ferguson?

The treating clinician sets the visit schedule based on the wound, the plan and who is changing dressings between visits. Chronic wounds are usually rechecked on a regular cycle so measurements can be compared, and the interval may change as the wound does. Gateway confirms what is available for your location and care setting and lets you know the schedule ahead of time.

Could a wound that will not heal be skin cancer?

Occasionally, yes. Some skin cancers look like a sore that never closes, and a wound that has been open for a very long time can, rarely, change. It is not the usual explanation, but it is one reason clinicians take a second look at wounds that do not respond to care. The treating clinician may take a small tissue sample to check. Ask about it if you are worried.

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.

My grandmother in Ferguson has no ride to appointments. How can Gateway help?

Gateway can arrange for a partner clinician to visit her at home in Ferguson, so no ride is needed for wound care or primary care visits. If the treating clinician orders something that requires travel, such as imaging or a specialist appointment, we can coordinate transportation arrangements and the appointment together. Call 314-325-0126, tell us her address and phone number, and we will check what is available.

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.