About arterial and mixed wounds

Arterial and mixed wounds mostly affect older adults whose blood vessels have been under strain for decades. The people clinicians see most often include those who smoke or used to, people with diabetes, and people with high blood pressure, high cholesterol or chronic kidney disease, including those on dialysis. Many have already had a heart attack, a stroke, or a stent or bypass in a leg. Calf cramping that comes on with walking and eases with rest is a common earlier clue.

Mixed wounds tend to appear in people with a long history of leg swelling, varicose veins or a past venous ulcer who later develop artery disease on top of it.

How the care plan is built

A care plan for an arterial wound usually runs on two tracks. One protects the wound: dressings matched to how dry or moist it is, padding and footwear that keep pressure and friction off the area, and a close watch for infection. The other addresses the blood supply, which may mean a referral to a vascular specialist to see whether a procedure could open or bypass the narrowed artery.

The treating clinician sets the order of these steps. Until circulation is understood, the plan tends to be cautious, with an emphasis on keeping stable tissue stable instead of pushing for fast changes at the wound.

Arterial and mixed wound care in North County

People in North County 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.

Much of North County was built as subdivisions of brick ranch homes and bungalows, and those one-story houses suit home visits well. The region also has apartment complexes, senior apartment buildings, assisted living and a number of skilled nursing and rehabilitation centers. Gateway arranges partner clinician visits across all of them, from a house in Florissant to a nursing facility in Bridgeton. For a home visit, we ask where the patient is most comfortable being seen. For a facility, we ask which days work on the unit. The treating clinician handles the clinical side.

When care happens at home

When a home health agency is already visiting, its nurses and the wound care clinician need to work from the same orders. Gateway shares the treating clinician’s plan with the agency, so dressing changes between wound visits follow it and nobody applies a compression wrap that was not ordered.

Supplies are handled the same way. Once the clinician writes orders for dressings, padding or protective footwear, we coordinate the supply request and follow up on delivery to the home. If dressings are left over from an earlier leg wound, show them to the clinician before using them, because an arterial wound may call for something different.

In a facility

Residents in memory care may not be able to say that a foot hurts or remember bumping a shin. With arterial disease, that makes staff observation the main early warning. Pain may show up as restlessness at night, guarding a foot, refusing shoes or pulling at a dressing.

The treating clinician takes these reports seriously and builds a plan the unit can carry out, with dressings that stay in place and footwear that protects without rubbing. Gateway coordinates visits around the resident’s routine, keeps the attending physician informed and gives the family one contact for updates.

Changes to report

A daily look at both feet catches many problems early. Tell the treating clinician about:

  • A new sore, blister or dark spot on a toe, heel or ankle
  • One foot that feels noticeably cooler than the other
  • Foot pain when lying flat that eases when you hang the foot over the edge of the bed
  • Skin around the wound turning red, shiny or tight
  • A dressing with a new smell or a new color of drainage

Do not wait for the next scheduled visit to mention these. Call 911 if the foot or leg abruptly goes cold, numb and discolored, or if you cannot move it.

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 North County →

How to get started in North County

Clinicians and facility staff referring a patient for arterial and mixed wound care in North County 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.

North County covers many towns and ZIP codes, so start with the exact address and the municipality. Have the patient’s phone number, insurance cards and doctor’s name ready. If a relative on another street or in another town helps with care, give us that number too. Gateway arranges care in Florissant, Hazelwood, Ferguson and Bridgeton, and across the city line in North St. Louis. Because the region is spread out, each visit is confirmed by location and care setting.

  • County: St. Louis County, Missouri
  • ZIP codes: 63031, 63033, 63034, 63042, 63135, 63136, 63137, 63138, 63134
  • Nearby hospitals: Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton (not affiliated with Gateway)
  • Nearby communities: Florissant, Hazelwood, Ferguson, Bridgeton, North St. Louis
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

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

Common questions

If I see a vascular specialist near North County, 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 North County.

What is an ankle-brachial index, and does it hurt?

It is a common circulation test. Blood pressure cuffs are placed on the arms and ankles, and a small handheld ultrasound device listens to the pulse while each cuff is inflated. Comparing ankle and arm pressures shows whether blood flow to the foot is reduced. The cuff squeeze can be uncomfortable for a moment, especially near a sore area, so tell the person doing the test where your wound is.

What should I have ready before the first visit for an arterial or mixed wound?

Helpful items include a current medication list, the names of your primary care clinician and any vascular or heart specialists, and results of past circulation tests or leg procedures if you have them. Set out the shoes and slippers you wear most. Write down when the wound started and when pain is worst. Gateway can request outside records for the treating clinician, so missing paperwork is no reason to delay calling.

Does it matter whether an address is in North County or in the City of St. Louis?

Not for requesting care. Gateway arranges visits on both sides of the city line, in North County and in North St. Louis. It does help to give the full address and ZIP code, because many North County mailing addresses say St. Louis. The exact location lets us match the patient with a partner clinician who sees people in that area.

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.