Understanding non-healing wounds
A stalled wound rarely stays exactly the same. Over weeks and months it tends to drift. It may look a little better for a stretch, then worse after a swollen week, a fall or a few missed dressing changes. Drainage rises and falls. The skin around it may turn soggy and pale from moisture, or dry, hard and callused at the rim.
The longer a wound stays open, the more its edges and base can change in ways that make closing harder, and the more opportunity bacteria have to settle in. That is why clinicians record size, depth and tissue appearance at each visit and compare them over time. A single snapshot says little. A month of measurements shows whether the plan is working or needs to change.
What an assessment covers
Part of building the plan is agreeing on the goal. For most people the goal is full closure, and the plan is aimed at removing whatever stands in the way. For some, especially people who are very frail or whose circulation cannot be improved, the treating clinician may talk with the patient and family about a different aim: keeping the wound stable, clean, comfortable and free of infection.
Either way, the clinician explains what they found, what they think is holding the wound back and what they recommend. You should come away knowing what the plan is, who does what, and how you will be able to tell whether it is working.
Local context: Ladue
Many households in Ladue have been in the same home for decades, and the house has not changed as its owner has. A bedroom upstairs can mean sleeping in a recliner, which keeps the legs down all night and pressure on the tailbone. An old tub makes washing a leg wound awkward. The partner clinician sees these things on a home visit and can account for them in the plan. Gateway also asks about long-used favorites, such as a flattened seat cushion or tight house shoes, that may be working against the wound.
Clayton Road and Ladue Road carry most of the traffic through Ladue, a residential city in Mid County just west of Clayton. Away from those two roads, the streets turn into quiet lanes with large wooded lots and houses set well back from the curb. Interstate 64 and Interstate 170 are both close. There is little commercial development inside the city limits, so most medical appointments mean a drive to a neighboring city. For someone with a wound or limited mobility, care arranged at home removes that trip.
At home between visits
Most of the work on a slow wound happens between visits. Dressings are changed on the schedule the clinician ordered, by the patient, a family member or a visiting nurse. Someone keeps an eye on the drainage and the skin around the wound. Leg elevation, pressure relief or wraps are kept up day after day.
Gateway helps keep that routine from breaking down. We ask whether the dressing is manageable, relay questions to the treating clinician and schedule the next visit. If something changes, such as a hospital stay or a new caregiver, tell us so the plan and the visit schedule can be revisited.
In a facility
For a resident in memory care, a wound that will not heal often has a behavioral side. The person may pull off dressings, scratch at the area, pace for hours on swollen legs, or be unable to say that something hurts. Staff who know the resident usually know these patterns well.
The treating clinician takes that knowledge into account when choosing dressings and how they are secured, and may suggest timing care for the calmest part of the resident’s day. A familiar staff member or relative at the visit helps. Gateway arranges those details ahead of time and updates the family or legal decision-maker afterward.
What to report and when to call 911
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
Two questions come up with nearly every stalled wound: what is this person eating, and what are they taking? Repair needs protein, calories, fluids and certain vitamins, and many older adults with wounds eat far less than they need. Some medicines, including steroids and drugs that act on the immune system, can slow repair as well.
Neither issue should be handled alone. Do not stop or change a medicine by yourself. A primary care clinician can review the full list with the wound in mind, check weight and labs, and weigh the tradeoffs. Arranging primary care alongside wound care makes that review far more likely to happen.
Getting care arranged in Ladue
To arrange non-healing wound care in Ladue, 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.
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 non-healing wounds, 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
- Post-surgical wounds
- Reopened (dehisced) surgical wounds
- Surgical site infections
- Skin tears and traumatic wounds
- Wounds with lymphedema
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Non-healing wound care in Clayton and Central County
- Non-healing wound care in Creve Coeur
- Non-healing wound care in University City
Common questions
How do I start non-healing wound care in Ladue if I do not have a referral?
Call 314-325-0126 or use the request form, which asks only for a name and phone number. Please leave medical details out of the form. We call back, ask about the wound, your location and the care setting, and confirm whether a partner clinician is available. With your permission we then request earlier records so the first visit is well informed.
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.
Could a wound that will not heal be skin cancer?
Occasionally, yes. Some skin cancers look like a sore that never closes, and a wound that has been open for a very long time can, rarely, change. It is not the usual explanation, but it is one reason clinicians take a second look at wounds that do not respond to care. The treating clinician may take a small tissue sample to check. Ask about it if you are worried.
Can a private caregiver or household assistant call Gateway on behalf of someone in Ladue?
Yes. A caregiver, family member or assistant can make the first call for a patient in Ladue. We will ask for the patient’s name, address and phone number, and who should be the main contact for scheduling. If a home health agency or hired caregiver is already helping, tell us so the treating clinician knows who else is involved. The web form takes contact details only, so share medical information by phone.
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.