What to know about venous leg ulcers
Several common beliefs about venous leg ulcers get in the way of healing. One is that the sore needs air so it can dry out and scab. In general, clinicians aim for a moist, protected wound, not a dry one. Another is that the dressing does the healing. The dressing manages drainage, while compression addresses the swelling that holds the ulcer open.
A third is that resting means sitting with the feet on the floor, which lets fluid collect. People also assume a red, weeping leg must be infected, when skin inflamed by vein disease can look much the same. Each of these is worth raising with the treating clinician.
What the treating clinician looks at
Before anything is wrapped, the treating clinician needs to know that the arteries in the leg can tolerate pressure. That usually means feeling for pulses in the foot, and often a bedside test that compares blood pressure at the ankle with blood pressure in the arm. If the result is unclear, further vascular testing may be ordered.
This step matters because some leg ulcers involve both vein and artery disease, and those call for a different plan. Once circulation is understood, the clinician decides whether compression is appropriate, which form to use and how firm it should be. The dressing choice follows, matched mainly to how much the ulcer drains.
Arranging this care in the Metro East
People in the Metro East with venous leg ulcers sometimes see a vascular specialist in St. Louis and receive the rest of their care in Illinois. That split can leave gaps, such as test results from one side of the river never reaching the clinician who wraps the leg on the other. Gateway gathers the records, including circulation studies done before compression, and shares them with the treating clinician. When a trip across the river for specialty care is needed, we help with scheduling and transportation. Whether a Missouri-based provider can be used under an Illinois plan is checked first, not assumed.
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.
At home between visits
When a home health agency is already visiting, its nurses commonly change dressings and reapply compression between the treating clinician’s visits. Gateway shares current orders with the agency so both work from the same plan, and we pass the nurses’ observations back. Supplies need the same attention. A draining venous ulcer can go through a large amount of absorbent dressings, padding and wrap layers in a week. We coordinate orders for the supplies the clinician specifies and check in before they run low. What a health plan pays for depends on the plan, the treating provider and the care needed.
In a facility
Residents in memory care may not understand why a leg is wrapped. They may pull at the bandage, scratch the skin beneath it or be unable to say that it feels too tight. The treating clinician takes that into account when choosing dressings and compression, and may adjust the plan when a resident does not tolerate a wrap. Staff observations carry extra weight here. Restlessness, guarding the leg, a change in walking or a new refusal to wear shoes can all signal discomfort. Gateway shares the clinician’s instructions with the care team and keeps the family or legal representative updated on visits and changes.
What to report and when to call 911
Some changes point beyond the ulcer to the rest of the body. Tell the treating clinician promptly about:
- New swelling, pain or tenderness in one calf or thigh
- Swelling that rises quickly in both legs
- Rapid weight gain over a few days
- Needing more pillows to breathe comfortably at night
- A fall or a new injury to the leg
Call 911 right away for sudden shortness of breath, chest pain, coughing up blood, or a racing heartbeat with lightheadedness. These can be signs of a blood clot in the lungs or a heart problem, and they should not wait for a scheduled visit.
Primary care and overall health
Venous disease is a long-term condition, and the ulcer is one episode in it. Once the skin closes, someone needs to keep watching the legs, renew orders for compression garments as they wear out, and decide whether a referral to a vein specialist makes sense. That ongoing role usually belongs to primary care. A primary care clinician also weighs how other treatments affect the leg, such as blood thinners after a clot or a change in blood pressure medicine. For patients without a regular clinician, or who can no longer get to an office, Gateway can arrange primary care visits alongside wound care so follow-up continues.
Getting care arranged in the Metro East
To arrange venous leg ulcer care in the Metro East, 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.
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
Other conditions and nearby communities
Read the full guide to venous leg ulcers, or see everything Gateway arranges on the mobile wound care in the Metro East page.
- Diabetic foot 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
- Wounds with lymphedema
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Venous leg ulcer care in Belleville
- Venous leg ulcer care in Edwardsville
- Venous leg ulcer care in O'Fallon
- Venous leg ulcer care in Collinsville
Common questions
Do I need a referral to start venous leg ulcer care in the Metro East?
No referral is needed to call Gateway. Patients, family members and caregivers can contact us directly, and hospitals, facilities and practices can refer as well. Some health plans have their own referral or authorization rules, which depend on the plan and the treating provider. We will tell you what records or orders the treating clinician needs before a first visit.
My mother lives in a nursing home in the Metro East. Can Gateway arrange venous ulcer care there?
Often, yes. Partner clinicians see residents in skilled nursing, assisted living, memory care and rehabilitation settings, working alongside the facility’s nurses and the attending physician. Start by telling us the facility’s name, or ask its nursing staff to contact Gateway. We confirm whether visits are available at that location and what the facility needs in order to begin.
What should I have ready before the first visit?
A few things help: a list of your medications and allergies, the names of your other clinicians, any recent hospital or clinic records about the leg, and results of circulation tests if you have had them. Keep the dressings and wraps you are using now so the clinician can see them. If a family member helps with your care, ask them to be present or available by phone.
Will I have to travel to Missouri for any part of my care if I live in the Metro East?
Visits are arranged where you live, so wound care or primary care follow-up at home does not involve a trip across the river. If the treating clinician recommends a test, a specialist or an outpatient service, that clinician will explain why and where. Gateway can help coordinate the appointment and transportation arrangements. You can always ask whether there is an option on the Illinois side.
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.