Wound care with lymphedema in the Metro East.

Understanding wounds with lymphedema

Wounds form on a limb with lymphedema because swollen tissue is fragile tissue. Fluid pushes skin cells farther from the small blood vessels that feed them, so oxygen and nutrients arrive slowly. The stretched surface tears easily, and a scratch from a pet, a bump against a bed frame or a rubbing shoe can open it.

Once the skin is open, lymph fluid seeps out. The steady moisture softens the surrounding skin until it turns white and breaks down, and the open area widens. Bacteria that would normally be carried away by lymph flow linger in the tissue. Each problem feeds the next, which is why treating clinicians usually address the swelling and the wound in the same plan.

What an assessment covers

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.

Wound care with lymphedema in the Metro East

Crossing the river for a lymphedema therapy appointment can take a large part of a day from the Metro East, with the leg down for the whole ride. Many people would rather have wound care come to them. Before a visit is scheduled, Gateway confirms two things: the treating provider who serves your address, and how that provider works with your coverage, whether that is Medicare, an Illinois Medicaid plan or a commercial plan. Participation and benefits depend on the provider, the plan and the care needed.

Care settings in the Metro East are as varied as the region. There are brick homes in older neighborhoods, farmhouses, subdivisions, apartments, mobile homes, senior living communities, memory care units, rehabilitation centers and skilled nursing facilities. Gateway arranges wound care and primary care visits with partner clinicians in all of these. We start by asking where the patient is living and who helps with daily care. Then we coordinate the visit with the household or the facility staff and make sure records and orders reach the treating clinician.

When care happens at home

Supplies run out quickly when a lymphedema wound is draining. Absorbent dressings, padding and wrap materials may be changed several times a week, and going without them for even a day or two can set the limb back. Gateway coordinates supply orders with the treating clinician’s orders and follows up with the supplier on delivery to your home.

Tell us when you are getting low, well before the last box is opened. It also helps to mention practical problems, such as fluid soaking through to bedding or furniture, or dressings that will not stay in place overnight. The clinician can often change the dressing or the plan to deal with them.

For residents of nursing and senior living communities

Rehabilitation stays are hard on swollen legs. Long sessions in a wheelchair with the feet down let fluid pool, and wraps can loosen or slide during therapy. The treating clinician works with physical and occupational therapists on timing and positioning, such as when wraps are checked, how leg rests are used and how much ankle movement and walking can be built into the day.

Discharge needs planning too. Before the resident goes home, someone has to know who will apply compression, where supplies will come from and who follows the wound. Gateway can arrange for visits to continue at home, with availability confirmed by location.

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

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.

Primary care at home in the Metro East →

How to get started in the Metro East

Clinicians and facility staff referring a patient for wound care with lymphedema in the Metro East 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.

Patients in the Metro East come home from many hospitals, including Memorial Hospital Belleville, Memorial Hospital Shiloh, HSHS St. Elizabeth’s Hospital in O’Fallon, Illinois, Anderson Hospital in Maryville, Alton Memorial Hospital, OSF Saint Anthony’s Health Center in Alton, Gateway Regional Medical Center in Granite City and Touchette Regional Hospital in Cahokia Heights. Gateway Wound Care is not affiliated with them. Whichever hospital it was, a family member or discharge planner can ask us to arrange follow-up. We obtain the discharge orders and set up a visit with a partner clinician at the home or facility.

• County: St. Clair, Madison and Monroe counties, Illinois
• Nearby hospitals: Memorial Hospital Belleville; Memorial Hospital Shiloh; HSHS St. Elizabeth's Hospital in O'Fallon, Illinois; Anderson Hospital in Maryville; Alton Memorial Hospital; OSF Saint Anthony's Health Center in Alton; Gateway Regional Medical Center in Granite City; Touchette Regional Hospital in Cahokia Heights (not affiliated with Gateway)
• Nearby communities: Belleville, Illinois, Edwardsville, O'Fallon, Illinois, Collinsville, Alton, Granite City
• Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in the Metro East

Read the full guide to wounds with lymphedema, or see everything Gateway arranges on the mobile wound care in the Metro East 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 Belleville
• Wound care with lymphedema in Edwardsville
• Wound care with lymphedema in O'Fallon
• Wound care with lymphedema in Collinsville

Common questions