Wound care with lymphedema in Ladue.

About wounds with lymphedema

Over weeks and months, a lymphedema wound tends to follow the swelling. When the limb is well controlled, drainage usually slows, the edges firm up and the open area gets smaller. When compression lapses, an infection sets in or the person spends long days sitting, the limb fills again and the wound can stall or reopen.

Because of this, progress is rarely a straight line. Setbacks are common and do not mean the plan has failed, but they should be reported. In time, the goal shifts from closing the wound to keeping the skin intact, with garments and skin care that continue for the long term. The treating clinician sets expectations for your situation. No one can promise a timeline.

What the treating clinician looks at

During the exam, the treating clinician looks at the wound and at all of the skin on the limb, since the next problem often starts a few inches from the current one. Typical points of attention include:

• Where the wound sits, its size and depth, and what the wound bed looks like
• How much it drains and what the fluid looks like
• Skin folds, including the base of each fold
• The spaces between the toes, where cracks and fungal infections hide
• Warmth, redness or tenderness that could mean infection

These findings guide the choice of dressing, how often it is changed, and whether an infection has to be dealt with before anything else.

Arranging this care in Ladue

Many people in Ladue have lived in the same house for decades and have managed swollen legs on their own for nearly as long, often with worn stockings and a routine that worked until the skin opened. Older homes add their own difficulties: a tub to step over when legs need washing, a bathroom up the stairs, a favorite chair with no way to raise the feet. A treating clinician visiting at home can see these and suggest workable changes. Gateway coordinates the visit and any garments or supplies ordered.

Most of Ladue is single-family homes, many of them large, on private lanes or at the end of long driveways. Some families have hired caregivers in the home. Apartments and senior living are less common in Ladue itself than in the cities around it, where many longtime residents move for assisted living, memory care or skilled nursing. Gateway arranges partner clinician visits in both places. For a home, we ask about gate codes, the easiest entrance and who will meet the clinician. For a facility, we work with the nursing staff on timing and orders.

At home between visits

A home visit lets the treating clinician see the limb in the place where the swelling actually builds. The chair you spend the day in, the height of your bed and whether you have any way to prop up your legs all affect how much fluid collects. Those details are hard to describe in an office and easy to see in a living room.

It also spares you the trip. Moving a heavy, wrapped, draining leg into a car and through a waiting room is exhausting, and some people put off care because of it. Gateway arranges visits with partner clinicians in private homes, with availability confirmed by location.

For residents of nursing and senior living communities

In a skilled nursing facility, a lymphedema plan succeeds or fails on consistency. A wrap put on firmly by the day shift and loosely by the evening shift does not control swelling, and gaps of a day or two let the limb refill. The treating clinician writes orders that are specific about the dressing, the compression and how often each is changed, and reviews them with the nurses who will carry them out.

Gateway coordinates the visit schedule with the facility and sends the orders and visit notes to the nursing team. Staff questions that come up between visits go back to the clinician.

Signs to tell the clinician about

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.

Primary care and overall health

Lymph flow in the legs gets much of its push from the calf and foot muscles squeezing with each step, so anything that limits walking tends to worsen swelling. Primary care can look at what is holding a person back, whether that is joint pain, breathlessness, weakness or fear of falling, and whether therapy would help.

General health affects the wound as well. Healing draws on protein and calories, high blood sugar slows repair and raises infection risk, and extra body weight adds pressure on lymph vessels in the groin and legs. These are long-term concerns that a primary care clinician follows alongside the wound visits.

Primary care at home in Ladue →

How to get started in Ladue

Clinicians and facility staff referring a patient for wound care with lymphedema in Ladue 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.

After a hospital stay, people in Ladue most often come home from Missouri Baptist Medical Center in Town and Country, SSM Health St. Mary’s Hospital in Richmond Heights or Mercy Hospital St. Louis in Creve Coeur. All three are a short drive away, and none is affiliated with Gateway. Families can call us to ask about wound care or primary care follow-up once a discharge date is set. Hospital discharge planners can refer by phone or fax and include the discharge summary, wound orders and the name of the person who will be at the home.

• County: St. Louis County, Missouri
• ZIP codes: 63124
• Nearby hospitals: Missouri Baptist Medical Center in Town and Country; SSM Health St. Mary's Hospital in Richmond Heights; Mercy Hospital St. Louis in Creve Coeur (not affiliated with Gateway)
• Nearby communities: Clayton and Central County, Creve Coeur, Richmond Heights, Brentwood, University City
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

Read the full guide to wounds with lymphedema, or see everything Gateway arranges on the mobile wound care in Ladue 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 Clayton and Central County
• Wound care with lymphedema in Creve Coeur
• Wound care with lymphedema in University City

Common questions