About arterial and mixed wounds

An arterial ulcer is an open sore that develops because the arteries feeding the leg or foot have narrowed and can no longer carry enough blood to keep skin alive and repair it. Clinicians also call these ischemic wounds. They show up most on the tips of the toes, between the toes, on the heel, over the ankle bone and along the shin, places far from the heart or pressed on by shoes. The sore is often small, deep and dry, with a clean border. A mixed wound, sometimes called a mixed arterial-venous ulcer, sits on a leg where the veins are also failing, so swelling and drainage appear alongside the signs of a poor arterial supply.

What an assessment covers

Beyond the wound itself, the treating clinician gathers the history that explains it. Expect questions about:

  • How the wound started and how long it has been open
  • Pain: where, when, and what eases it
  • How far you can walk before your calves or feet hurt
  • Tobacco use, diabetes and past heart or vascular procedures
  • Shoes, slippers and whether you sleep in a bed or a recliner

The answers feed a plan with clear goals. For some people the aim is closure once circulation improves. For others, particularly when a procedure is not an option, the aim is comfort, protection and preventing infection.

Arranging this care in Florissant

People in Florissant often move between settings without going far: a hospital stay for a vascular procedure, a few weeks in a nearby skilled nursing or rehabilitation center, then home or to a senior living community close by. An arterial wound has to be followed through each move, and orders about compression, dressings and weight on the foot must travel with it. Gateway keeps the wound records and the treating clinician’s current orders together across those handoffs, so each new nursing team starts from the same plan and the family is not left carrying paperwork.

Single-story ranch houses are the typical Florissant home, which helps patients who cannot manage stairs. The city also has garden apartments, condominiums, senior apartment communities, assisted living, and skilled nursing and rehabilitation centers. Gateway arranges partner clinician visits in every one of these settings. A request can come from a homeowner, a relative or a facility’s nursing office. We then match the visit to the setting: a time of day that suits a family caregiver at home, or a time that works with medication passes and therapy in a facility.

Care at home

Between visits, most of the daily work falls to you or a caregiver, guided by the clinician’s written instructions. That usually means looking at both feet every day, including between the toes and the backs of the heels, keeping the dressing as ordered, and wearing the footwear or heel protection the clinician recommended.

Gateway stays involved during these stretches. If something changes, a call to 314-325-0126 gets the message to the treating clinician’s team. If a vascular appointment is coming up, we confirm the date, the records and the ride so the trip is not wasted.

In a facility

In a skilled nursing facility, partner clinicians see residents with arterial or mixed wounds on site and write recommendations for the attending physician and nursing staff. Facility nurses carry out the daily dressing orders and are well placed to catch change early, since they see the foot every shift.

Gateway coordinates the visit schedule with the director of nursing or wound nurse, sends visit notes for the chart, and tracks open items such as a pending circulation test. Clear documentation of whether compression is ordered for each leg matters here, because staff rotate and a routine wrap on the wrong leg is an avoidable error.

What to report and when to call 911

For a mixed wound, watch both the swelling and the circulation. Report these to the treating clinician:

  • Swelling that rises quickly or spreads up the leg
  • Toes that turn pale, blue or numb, or new pain, while a wrap or stocking is on
  • Drainage soaking through dressings sooner than before
  • New blisters or breaks in the skin near the wound
  • Fever, chills or feeling unwell

Call 911 for a leg that suddenly becomes cold, white or blue and very painful, for chest pain or trouble breathing, or for signs of stroke such as a drooping face, weakness in one arm or slurred speech.

How primary care fits in

Peripheral artery disease is rarely limited to the legs. The same buildup that narrows a leg artery often affects the vessels of the heart and brain, which is why a foot wound from poor circulation leads clinicians to look at the whole person.

A primary care clinician manages blood pressure, cholesterol and diabetes, and reviews the medications prescribed to protect the heart and blood vessels. Gateway can arrange primary care alongside wound care, so the clinician dressing the wound and the clinician managing overall health share records and each knows what the other has ordered.

Primary care at home in Florissant →

Getting care arranged in Florissant

Setting up arterial and mixed wound care for someone in Florissant 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.

Florissant is big enough that location within the city matters. Tell us the ZIP code, the nearest major road and whether the home is north toward the Missouri River or south near Interstate 270. Have the patient’s phone number, the doctor’s name and the name of a second contact. Ask us about timing if a caregiver is only there at certain hours. Gateway also arranges care in Hazelwood, Ferguson, Bridgeton and the rest of North County, and visits in Florissant are planned with those areas.

  • County: St. Louis County, Missouri
  • ZIP codes: 63031, 63033, 63034
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Hazelwood, Ferguson, North County, Bridgeton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Florissant

Read the full guide to arterial and mixed wounds, or see everything Gateway arranges on the mobile wound care in Florissant page.

Common questions

Do I need a referral to ask about arterial wound care in Florissant?

No. Patients, family members and caregivers in Florissant can contact Gateway directly, and hospitals, facilities and physician offices can refer as well. Some health plans do require a referral or authorization before certain visits or tests, and the treating clinician may need earlier records. We explain what is needed for your situation after the first call, before a visit is scheduled.

What is an ankle-brachial index, and does it hurt?

It is a common circulation test. Blood pressure cuffs are placed on the arms and ankles, and a small handheld ultrasound device listens to the pulse while each cuff is inflated. Comparing ankle and arm pressures shows whether blood flow to the foot is reduced. The cuff squeeze can be uncomfortable for a moment, especially near a sore area, so tell the person doing the test where your wound is.

Why should I be careful with a heating pad or warm soak when my feet feel cold?

Feet with poor circulation often have reduced feeling as well, and skin that cannot sense heat or carry it away can burn at temperatures that seem mild. A burn on a poorly supplied foot becomes another wound to manage. Clinicians commonly suggest loose warm socks and blankets instead, and advise against soaking a foot with an open wound unless they have ordered it. Ask the treating clinician before using direct heat.

Can a skilled nursing or assisted living facility in Florissant request visits for a resident?

Yes. Facility staff in Florissant can refer by phone or fax, and one request can cover a single resident or start a conversation about regular visits for several. We ask for the resident’s information, the reason for the request and the best nursing contact. The treating clinician works alongside the facility’s own team and attending physician, and visit notes are shared with them.

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.