What to know about arterial and mixed wounds

Arterial and mixed wounds mostly affect older adults whose blood vessels have been under strain for decades. The people clinicians see most often include those who smoke or used to, people with diabetes, and people with high blood pressure, high cholesterol or chronic kidney disease, including those on dialysis. Many have already had a heart attack, a stroke, or a stent or bypass in a leg. Calf cramping that comes on with walking and eases with rest is a common earlier clue.

Mixed wounds tend to appear in people with a long history of leg swelling, varicose veins or a past venous ulcer who later develop artery disease on top of it.

What the treating clinician looks at

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.

Local context: Franklin County

Around Franklin County, the nearest vascular specialist may be a long drive away, and a late dressing delivery cannot be fixed with a quick errand. Planning matters more here. Gateway works from the treating clinician’s orders to keep dressings and protective padding stocked in the home ahead of need, and schedules wound visits at the house so travel is reserved for testing and procedures. We also help families plan those longer trips: which records to bring, how the foot will be protected on the ride, and how results get back to the wound care team.

Homes in Franklin County include houses in town in Washington, Union and Pacific, subdivisions near the highways, manufactured homes, and farmhouses at the end of long gravel drives. Senior apartments, assisted living and skilled nursing facilities are concentrated in the larger towns. Gateway arranges partner clinician visits across these settings, with attention to the practical side: exact directions, whether a regular car can make the driveway, and whether cell phones work at the house. In facilities, we coordinate with the nursing staff so the treating clinician’s orders and supplies arrive together.

At home between visits

Family caregivers are often the first to notice trouble with an arterial wound, because they see the foot every day. The treating clinician can show a spouse, adult child or paid aide what the wound should look like, how the dressing is handled under the current orders, and which changes call for a phone call.

Caregivers also help in quieter ways: checking that socks and shoes are not leaving marks, keeping walkways clear so toes are not stubbed, and making sure bedding is not pressing on sore toes at night. Gateway can include a caregiver on scheduling calls and updates when the patient agrees.

For residents of nursing and senior living communities

Many people arrive at a rehabilitation center after a hospital stay for a vascular procedure, an infection or a toe amputation, with a wound that still needs close follow-up. Therapy adds a complication: the foot has to bear weight and wear a shoe again.

The treating clinician works with facility nursing and therapists on how the wound is protected during sessions, and with the attending physician on orders. Gateway obtains the hospital’s operative and vascular reports, lines up any follow-up visit the surgeon requested, and plans how wound care will continue at home or in long-term care after discharge.

Signs to tell the clinician about

Infection can move fast in tissue that is short on blood, and the usual warmth and redness may be faint. Report promptly:

  • A dry wound that becomes wet, soft or foul-smelling
  • Red streaks or swelling moving up the foot or leg
  • Fever, chills, or new confusion in an older adult
  • Blood sugar running higher than usual, if you have diabetes
  • A sudden rise in pain

Call 911 for a suddenly cold, pale or blue limb, severe pain with numbness or loss of movement, bleeding that will not stop, or a fever that comes with fainting, a racing heart or confusion.

Why primary care matters here

Healing draws on the whole body. High blood sugar damages small vessels and weakens the response to infection. Kidney disease, anemia and a poor appetite each limit what reaches the wound. A primary care clinician can check labs, review how well diabetes is controlled, and look at whether you are eating enough protein and calories to rebuild tissue.

When wound care and primary care are arranged together, a wound that stalls prompts a wider look at health and not only a change of dressing. Findings from either visit reach the other clinician through Gateway’s coordination.

Primary care at home in Franklin County →

Arranging arterial and mixed wound care in Franklin County

To arrange arterial and mixed wound care in Franklin County, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.

Be specific about location when you call. Franklin County is large, and a Union or St. Clair mailing address can be many miles from town. Give the ZIP code (63090, 63084, 63069, 63077 or 63080 for the main towns), the road name, and landmarks near your turn. Tell us the days someone is home. Visits this far west are planned by area, often together with nearby Eureka, Wildwood or northern Jefferson County, so we may offer particular days. Availability is always confirmed by location and care setting.

  • County: Franklin County, Missouri
  • ZIP codes: 63090, 63084, 63069, 63077, 63080
  • Nearby hospitals: Mercy Hospital Washington (not affiliated with Gateway)
  • Nearby communities: Washington, Missouri, Eureka, Wildwood, Jefferson County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Franklin County

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

Common questions

If I see a vascular specialist near Franklin County, who keeps everyone informed?

Gateway does much of that work. When the treating clinician refers you to a vascular specialist, we send the wound records, help schedule the appointment, arrange transportation if needed and request the visit notes and test results afterward. Those go back to the wound care clinician and, with your permission, your primary care office. You should not have to carry messages between offices in or near Franklin County.

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.

What should I have ready before the first visit for an arterial or mixed wound?

Helpful items include a current medication list, the names of your primary care clinician and any vascular or heart specialists, and results of past circulation tests or leg procedures if you have them. Set out the shoes and slippers you wear most. Write down when the wound started and when pain is worst. Gateway can request outside records for the treating clinician, so missing paperwork is no reason to delay calling.

Can someone in Franklin County use Gateway and still keep their local doctor?

Yes. Arranging wound care or in-home follow-up through Gateway does not replace the family doctor in Washington, Union or wherever the patient goes. The treating clinician handles the visits Gateway arranges, and notes are sent to the local doctor so everyone is working from the same information. Tell us the doctor’s name and office when you call so we can set that up.

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.