What to know about non-healing wounds

Anyone can have a wound that stalls, but some people are more likely to. Older adults are seen most often, because skin thins with age and repair slows. People living with diabetes, vein disease, narrowed leg arteries, heart failure or kidney disease are also common, since each condition affects blood flow, swelling or the body’s ability to rebuild tissue.

Limited mobility raises the odds too. Someone who spends most of the day in a wheelchair, recliner or bed puts steady pressure on the same areas. People who have lost feeling in their feet may not notice a shoe rubbing until the skin has broken. People who smoke, people recovering from a long hospital stay and people who are eating very little also turn up often with wounds that will not close.

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.

Non-healing wound care in Franklin County

Running out of dressings is a bigger problem in Franklin County than it is closer to St. Louis, because a replacement may be days away. Gateway plans supply orders with extra lead time and asks about quantities before each visit. If the treating clinician orders a blood flow study, imaging or a specialist consult, we help line up the appointment, records and ride so one trip covers as much as possible. Clear written instructions and a list of changes to report matter more when help is far away, so we check that you have both.

Franklin County lies west of St. Louis County, where the suburbs thin out into river towns, farms and wooded hills. Interstate 44 runs through Pacific, St. Clair and Sullivan. Washington sits on the Missouri River to the north, and Union, the county seat, is in between. Distances are measured differently here. A trip to a specialist can take most of a morning, and winter weather or high water can close a road. For residents who need frequent wound care or regular medical follow-up, having a clinician come to the home or facility can be the most workable arrangement.

Care 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.

In a facility

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.

Changes to report

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

The legs and feet show what the heart, kidneys and blood vessels are doing. Fluid that builds up with heart failure or kidney disease stretches the skin and floods a leg wound with drainage. Narrowed arteries starve it of oxygen. Anemia means the blood carries less of what new tissue needs.

These conditions are followed in primary care and by specialists, with monitoring that changes over time. When the wound clinician and the primary care clinician share notes, a swollen week or a new lab result gets connected to what is happening at the wound, and referrals for circulation problems are less likely to sit unanswered.

Primary care at home in Franklin County →

Arranging non-healing wound care in Franklin County

Clinicians and facility staff referring a patient for non-healing wound care in Franklin County can call 314-325-0126 or fax 314-786-7966. Helpful to include: demographics and insurance, the working diagnosis, recent wound notes and measurements, current orders, the medication list and relevant test results. Please also tell us who should receive the treating clinician’s notes afterward. The online referral form takes contact details only, so clinical records should come by fax, not through the form. Gateway confirms that the referral arrived, checks availability for the patient’s address and lets your office know what has been scheduled.

Mercy Hospital Washington is the hospital many Franklin County residents use, and some patients are sent on to larger hospitals in St. Louis for surgery or specialty care. Gateway is not affiliated with any hospital. Whichever one the patient is leaving, the handoff works the same way. The discharge planner faxes a referral with the wound orders, or the family calls with the discharge date. We collect the records, confirm the home or facility address in Franklin County, and arrange follow-up with a treating clinician, so the wound has a plan after discharge.

  • 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

Other conditions and nearby communities

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

Common questions

Is there someone in Franklin County who can check a relative’s wound at an assisted living or nursing facility?

Gateway arranges visits in skilled nursing, assisted living, memory care and rehabilitation settings as well as private homes. If your relative lives in a facility in Franklin County, call us with the facility name. We confirm availability for that location, coordinate with the nursing staff and attending physician, and keep you updated if you are the resident’s contact or decision-maker.

Can a wound that has been open for years still heal?

Sometimes, and it is worth asking. The length of time alone does not rule out improvement. What matters is whether the things holding the wound back can be found and changed. Some long-standing wounds do close after the cause is addressed. Others cannot fully heal, and the aim becomes comfort and preventing infection. The treating clinician can give you an honest view after an assessment.

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.

Which towns in Franklin County can request care through Gateway?

Requests are welcome from Washington, Union, Pacific, St. Clair, Sullivan and the smaller communities and rural routes around them. Franklin County covers a lot of ground, so availability varies more here than in the inner suburbs. Call with the address and ZIP code, and we will check which partner clinicians are seeing patients in that part of the county and what can be arranged.

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.