What to know about arterial and mixed wounds

An arterial ulcer is an open sore that develops because the arteries feeding the leg or foot have narrowed and can no longer carry enough blood to keep skin alive and repair it. Clinicians also call these ischemic wounds. They show up most on the tips of the toes, between the toes, on the heel, over the ankle bone and along the shin, places far from the heart or pressed on by shoes. The sore is often small, deep and dry, with a clean border. A mixed wound, sometimes called a mixed arterial-venous ulcer, sits on a leg where the veins are also failing, so swelling and drainage appear alongside the signs of a poor arterial supply.

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: Maryland Heights

People in Maryland Heights often move between settings without going far: a hospital stay for a vascular procedure, a few weeks in a nearby skilled nursing or rehabilitation center, then home or to a senior living community close by. An arterial wound has to be followed through each move, and orders about compression, dressings and weight on the foot must travel with it. Gateway keeps the wound records and the treating clinician’s current orders together across those handoffs, so each new nursing team starts from the same plan and the family is not left carrying paperwork.

Ranch houses and split-levels fill many Maryland Heights subdivisions, and apartment and condominium complexes sit along the main roads. Some buildings have elevators and some are garden-style walk-ups, which is worth mentioning when you call. The area also has senior apartments, assisted living, and skilled nursing and rehabilitation centers. Gateway arranges visits by partner clinicians in each setting. For apartments we note the building, unit number and entry code. For facilities we coordinate visit times with the nursing staff and send the treating clinician’s orders to the right desk.

Care at home

Between visits, most of the daily work falls to you or a caregiver, guided by the clinician’s written instructions. That usually means looking at both feet every day, including between the toes and the backs of the heels, keeping the dressing as ordered, and wearing the footwear or heel protection the clinician recommended.

Gateway stays involved during these stretches. If something changes, a call to 314-325-0126 gets the message to the treating clinician’s team. If a vascular appointment is coming up, we confirm the date, the records and the ride so the trip is not wasted.

Care in skilled nursing and assisted living

In a skilled nursing facility, partner clinicians see residents with arterial or mixed wounds on site and write recommendations for the attending physician and nursing staff. Facility nurses carry out the daily dressing orders and are well placed to catch change early, since they see the foot every shift.

Gateway coordinates the visit schedule with the director of nursing or wound nurse, sends visit notes for the chart, and tracks open items such as a pending circulation test. Clear documentation of whether compression is ordered for each leg matters here, because staff rotate and a routine wrap on the wrong leg is an avoidable error.

What to report and when to call 911

For a mixed wound, watch both the swelling and the circulation. Report these to the treating clinician:

  • Swelling that rises quickly or spreads up the leg
  • Toes that turn pale, blue or numb, or new pain, while a wrap or stocking is on
  • Drainage soaking through dressings sooner than before
  • New blisters or breaks in the skin near the wound
  • Fever, chills or feeling unwell

Call 911 for a leg that suddenly becomes cold, white or blue and very painful, for chest pain or trouble breathing, or for signs of stroke such as a drooping face, weakness in one arm or slurred speech.

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 Maryland Heights →

Arranging arterial and mixed wound care in Maryland Heights

To arrange arterial and mixed wound care in Maryland Heights, 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.

For a Maryland Heights address, tell us the nearest major road, such as Dorsett Road, McKelvey Road or Page Avenue, along with the apartment or unit number if there is one. Have a callback number, the regular doctor’s name and the date of any recent hospital stay. Gateway also arranges care in Creve Coeur, Bridgeton, Overland, Hazelwood, and Chesterfield and West County. Highway access here is good, but visit days are still set according to the care setting and the partner clinician’s schedule.

  • County: St. Louis County, Missouri
  • ZIP codes: 63043
  • Nearby hospitals: Mercy Hospital St. Louis in Creve Coeur; Barnes-Jewish West County Hospital in Creve Coeur; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Creve Coeur, Bridgeton, Overland, Chesterfield and West County, Hazelwood
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in Maryland Heights

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

Common questions

If I see a vascular specialist near Maryland Heights, 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 Maryland Heights.

Is walking good or bad when I have a foot wound from poor circulation?

Walking is commonly recommended for artery disease in general, but an open wound on the foot changes the picture. Pressure and rubbing can hold a wound back, and the right shoe or protective device matters. Ask the treating clinician how much to walk, what to wear on the foot and whether any part of it should be kept free of weight. The answer is individual.

Can an arterial ulcer heal without a procedure to open the artery?

Some do and some do not. It depends mainly on how much blood is reaching the area, along with infection, diabetes control and overall health. The treating clinician and, when involved, a vascular specialist weigh whether local wound care is likely to be enough or whether improving blood flow should come first. Not everyone is a candidate for a procedure, and in that case the plan centers on protection and comfort.

I care for my wife in Maryland Heights and work during the day. Can visits be planned around my schedule?

Tell us when you are home and when you are not. Gateway passes your preferences to the partner clinician’s office and confirms a visit day with you. We cannot promise a particular time, but we can note who else may be present, such as a relative or aide, and where to send updates so you know what the treating clinician found and ordered.

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.