Understanding non-healing wounds
Several common beliefs about slow wounds do not hold up. One is that a wound should be left open to the air to dry out and scab. For most chronic wounds clinicians aim for a moist, protected surface instead, though the choice of dressing is theirs to make. Another is that no pain means no problem. People with nerve damage can have a serious wound and feel almost nothing.
A third mistake is treating a wound that will not heal as a normal part of getting older. Age slows repair, but age alone does not keep a wound open. And many families assume a stronger cream is the missing piece, when the real barrier is pressure, swelling or blood flow that no ointment can correct.
How the care plan is built
When a wound has not responded to reasonable care, the treating clinician may want more information than an exam can give. Depending on the findings, that can mean a check of blood flow to the leg, blood work, a culture, imaging of the bone beneath the wound, or a small tissue sample to rule out an unusual cause.
Not every wound needs every test. The clinician chooses based on where the wound is, how it looks and how it has behaved. Gateway’s part is practical: we help get the orders to the right lab or imaging service, track the results and see that they reach the clinician before the next decision is made.
Local context: North County
People in North County often move between home, a nearby rehabilitation unit and a senior living community as their health changes, and a chronic wound travels with them. Each move risks a different dressing, a lost measurement history and a new set of nurses starting from zero. Gateway keeps the wound’s history together across those settings and arranges for a treating clinician to follow it where the person is staying, when availability allows. If an adult child nearby helps with dressings, we include them in scheduling and updates when the patient agrees.
North County is the name St. Louisans give to the northern part of St. Louis County, roughly the area north of Interstate 70. It takes in Florissant, Hazelwood, Ferguson, Bridgeton, Berkeley, Jennings, Black Jack, Bellefontaine Neighbors and unincorporated Spanish Lake, and it runs north and east to the Missouri and Mississippi rivers. Interstate 270 and Interstate 170 tie these communities together. Many families have lived here for generations, and many longtime homeowners are now older adults. Care arranged at home or in a nearby facility helps them stay close to family, church and neighbors.
At home between visits
Many people with a long-standing wound already have a home health agency involved. When that is the case, the partner clinician and the agency nurses work from the same orders. The nurses carry out dressing changes and report measurements, and the clinician adjusts the plan at each visit. Gateway shares visit notes with the agency so both sides see the same picture.
Supplies are the other piece. Running out of the ordered dressing and substituting whatever is in the cabinet is a common way for wounds to slip backward. We help route supply orders through the proper channel and ask about quantities before they run low.
For residents of nursing and senior living communities
In a skilled nursing facility, a wound that has not improved is a shared concern for the nurses, the attending physician, the family and often the facility’s own wound nurse. A partner clinician arranged through Gateway sees the resident at the bedside, reviews the treatment record and weekly measurements, and talks with the nurse who knows the wound.
Recommendations and orders go through the facility’s normal process, with the attending physician kept informed. Floor staff continue the daily dressing changes and turning schedule. Gateway coordinates visit days with the facility and sends documentation back for the chart.
What to report and when to call 911
Because these wounds are judged by their trend, small shifts matter. Report any of the following between visits instead of waiting for the next one:
- The wound looks wider or deeper, or a new opening appears nearby
- Black, gray or yellow tissue that was not there before
- Bone, tendon or surgical hardware visible in the base
- Bleeding at a light touch
- Fever, chills, nausea or unusual tiredness
- A dressing that will not stay in place or cannot be done as ordered
Call 911 if a foot or leg suddenly becomes cold, pale or blue, or if the person is hard to wake, breathing fast or suddenly not making sense.
Primary care and overall health
The legs and feet show what the heart, kidneys and blood vessels are doing. Fluid that builds up with heart failure or kidney disease stretches the skin and floods a leg wound with drainage. Narrowed arteries starve it of oxygen. Anemia means the blood carries less of what new tissue needs.
These conditions are followed in primary care and by specialists, with monitoring that changes over time. When the wound clinician and the primary care clinician share notes, a swollen week or a new lab result gets connected to what is happening at the wound, and referrals for circulation problems are less likely to sit unanswered.
Arranging non-healing wound care in North County
For a resident of a nursing home, assisted living or memory care community in North County, a request for non-healing wound care can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.
Christian Hospital, near Interstate 270, and SSM Health DePaul Hospital in Bridgeton are the two hospitals people in North County use most. Gateway is not affiliated with either one. The first days at home after discharge are when dressing questions and supply gaps tend to show up, so it helps to set up follow-up early. Families can call 314-325-0126 before the patient leaves the hospital. Discharge planners can fax referrals to 314-786-7966 with the summary and wound orders. Gateway then confirms which partner clinician can see the patient at the North County address.
- 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
More wound care in North County
Read the full guide to non-healing wounds, or see everything Gateway arranges on the mobile wound care in North County 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 Florissant
- Non-healing wound care in Hazelwood
- Non-healing wound care in Ferguson
- Non-healing wound care in North St. Louis
Common questions
How often will someone visit for a wound that is not healing in North County?
The treating clinician sets the visit schedule based on the wound, the plan and who is changing dressings between visits. Chronic wounds are usually rechecked on a regular cycle so measurements can be compared, and the interval may change as the wound does. Gateway confirms what is available for your location and care setting and lets you know the schedule ahead of time.
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.
Will the clinician need to remove tissue from the wound, and does it hurt?
Removing dead or unhealthy tissue, called debridement, is common in chronic wound care because that tissue blocks repair and shelters bacteria. Whether it is needed, and by which method, is the treating clinician’s decision. Some methods are gentle and gradual. Others are done with instruments, with attention to comfort. Tell the clinician about your pain beforehand and ask what to expect.
Which North County communities does Gateway arrange care in?
Gateway arranges wound care and primary care across North County, including Florissant, Hazelwood, Ferguson, Bridgeton, Berkeley, Jennings, Black Jack, Bellefontaine Neighbors and Spanish Lake. That takes in ZIP codes such as 63031, 63033, 63034, 63042 and 63136. If you are not sure whether an address falls in the area, call 314-325-0126 and we will check. Availability is confirmed by location and care setting.
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.