What to know about wounds with lymphedema
People whose swelling has been present for a long time are the ones most likely to develop a lymphedema wound. That includes people who had lymph nodes removed or treated with radiation for cancer, people with long-standing vein disease in the legs, and people who have had skin infections in the same limb more than once. Severe obesity can overload the lymphatic system. So can spending most of the day seated with the legs down, which is common after a stroke, with advanced arthritis, or with heart and lung conditions that limit walking.
A smaller group is born with lymph vessels that did not form normally, and their swelling may begin in childhood or early adulthood. Older adults often have several of these causes at once.
What the treating clinician looks at
Lymphedema wound care is built in stages, and the plan is expected to change. Early on, the focus is on reducing the swelling and controlling drainage, and wraps may need frequent adjustment as the limb shrinks and they loosen. At each visit the treating clinician measures the wound, and often the limb itself, and compares the numbers with earlier visits.
When the limb size has settled, attention turns to maintenance. That may mean fitting a garment for daily wear and deciding whether a lymphedema therapist should be involved. If the measurements stop improving, the clinician looks again at the cause, the fit of the compression and what is happening between visits.
Arranging this care in Jefferson County
Lymphedema therapists and wound specialists are scarce outside the metro core, and from Jefferson County the nearest one may be a long drive away. Care brought to the home matters more here. Visits are planned ahead, and supplies are too: a leaking leg uses absorbent dressings fast, and the local pharmacy may not stock the right ones. Gateway works with the treating clinician and the supplier so orders are placed before you run short. Ask at each visit what to do if a wrap fails before the next one.
Jefferson County has subdivisions and apartments in Arnold and Imperial, older homes in the river towns, manufactured homes, lake communities, and houses on acreage reached by gravel roads. Skilled nursing, rehabilitation and assisted living facilities are found mainly in the larger towns. Gateway arranges partner clinician visits in private homes and in facilities throughout the county. For homes, we collect directions and access notes. For facilities, we work with the nursing team so that wound orders, supply deliveries and visit days are understood by every shift.
Care at home
Most of the work on a lymphedema wound happens between visits. The treating clinician leaves instructions for the days in between, and they usually cover washing and thoroughly drying the skin, using a moisturizer if one is ordered, keeping wraps or garments on as directed and resting with the limb raised.
Wraps slip, dressings soak through and questions come up. Ask at the visit whom to call when that happens and what to do in the meantime, so no one is left guessing on a weekend. If part of the routine is not working, say so. A plan can be adjusted, but only if the clinician hears about the problem.
Care in skilled nursing and assisted living
Memory care and assisted living bring their own challenges for lymphedema. A resident with dementia may pull at a wrap, unroll it or be unable to say that it hurts, so staff need to know what to watch for: toes changing color, a wrap bunched behind the knee, fluid soaking through. The treating clinician takes this into account when choosing the type of compression.
Assisted living staff are often not permitted to change dressings or apply wraps. In that case the clinician may order home health nursing to come to the apartment, and Gateway coordinates among the agency, the community and the family.
Changes to report
Compression should feel snug and supportive. It should not hurt. Report these problems to the treating clinician, and ask ahead of time what to do if one of them shows up at night or on a weekend:
- Numbness, tingling or a pins-and-needles feeling below the wrap
- Toes or fingers that look pale, blue or dusky, or feel cold
- Pain that builds under the wrap instead of easing
- A wrap that has slid down, bunched up or formed a tight band
- Fluid soaking through the outer layer
Call 911 for chest pain, sudden shortness of breath, or a foot or hand that turns cold, white and severely painful.
Why primary care matters here
Because lymphedema lasts longer than any single wound, someone needs to hold the long view. A primary care clinician can track how often skin infections return, check the feet and toenails for the fungal problems that let bacteria in, and serve as the point of contact for the other specialists you see.
Gateway arranges wound care and primary care together for this reason. When the wound visits wind down, there is already a clinician who knows the history, the garments in use and what an early flare looks like for you. Questions such as who reorders garments, and how often the limb should be rechecked, have a place to go.
Getting care arranged in Jefferson County
Clinicians and facility staff referring a patient for wound care with lymphedema in Jefferson 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.
Where a Jefferson County resident is hospitalized usually depends on where they live. In the south and center it tends to be Mercy Hospital Jefferson in Festus. In the north, many go to Mercy Hospital South or SSM Health St. Clare Hospital in Fenton, both just over the county line. Gateway is not affiliated with these hospitals. A discharge planner at any of them can fax a referral, and families can call us. We request records, confirm the patient’s Jefferson County address and care setting, and arrange a follow-up visit with a treating clinician.
- County: Jefferson County, Missouri
- ZIP codes: 63010, 63028, 63019, 63052, 63012, 63050, 63020, 63049, 63051
- Nearby hospitals: Mercy Hospital Jefferson in Festus; Mercy Hospital South; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
- Nearby communities: Arnold, Festus and Crystal City, Imperial, Fenton, Oakville
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
Related care in Jefferson County
Read the full guide to wounds with lymphedema, or see everything Gateway arranges on the mobile wound care in Jefferson County page.
- Diabetic foot ulcers
- Venous leg ulcers
- Pressure injuries and bed sores
- Arterial and mixed wounds
- Non-healing wounds
- Post-surgical wounds
- Reopened (dehisced) surgical wounds
- Surgical site infections
- Skin tears and traumatic wounds
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Wound care with lymphedema in Arnold
- Wound care with lymphedema in Festus and Crystal City
- Wound care with lymphedema in Oakville
Common questions
Will Medicare or my health plan pay for lymphedema wound care in Jefferson County?
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.
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.
Could a compression pump help my lymphedema wound?
A pneumatic compression pump is a sleeve that inflates and deflates in sequence to move fluid out of a limb. Some people with lymphedema use one at home as part of a larger plan. It is not suitable for everyone, and concerns such as heart conditions, blood clots or active infection have to be considered first. The treating clinician decides. If one is ordered, Gateway coordinates the documentation and the equipment order.
How do hills, gravel roads and winter weather affect home visits in Jefferson County?
They are part of planning here. Tell us if your road is steep, unpaved or hard to pass after rain or snow, and whether there is a place to turn around. In bad weather a visit may need to be moved for safety, and we will contact you to reschedule. Ask the treating clinician what to watch for and what to do if a visit is delayed.
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.