What to know about arterial and mixed wounds

Leg arteries narrow slowly as fatty deposits build up inside their walls, a condition called peripheral artery disease. For years the body copes by widening smaller side vessels. Then demand rises: a blister from a new shoe, a nick while trimming a nail, a scrape against a wheelchair footrest. Repairing an injury takes far more oxygen than keeping intact skin alive, and the narrowed arteries cannot supply the difference. The injury stalls and becomes an ulcer.

In a mixed wound, weak vein valves add a second problem. Fluid pools in the lower leg, the tissue swells and the skin breaks down more easily, while the limited arterial flow slows every stage of repair.

What the treating clinician looks at

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 St. Louis

In North St. Louis, the building itself is part of the care plan. A third-floor walk-up is hard on anyone whose calves cramp after a short distance, and each trip down the stairs for an appointment risks a bumped toe or shin. Care brought to the apartment avoids that. When Gateway schedules a visit, we ask about entry codes, buzzers, elevators and where a visiting clinician can park, so the time goes to the wound. For vascular testing at a nearby medical center, we help arrange transportation suited to someone who cannot walk far.

The housing here is mostly brick: two-story single-family homes, two-family and four-family flats, and senior apartment buildings, usually with steps up to the front door. Second-floor flats and steep stairs are a real obstacle for someone with a leg wound or poor balance. Skilled nursing facilities and assisted living are part of the picture too. Gateway arranges partner clinician visits in any of these settings. When you call, tell us about the steps, which door to use and whether someone will be home, so the visit can start without delays.

At home between visits

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.

Care in skilled nursing and assisted living

Assisted living staff usually help with daily routines but may not perform wound care, so arterial wounds in these communities often involve a home health agency, the resident’s own physician and family. Gateway helps connect those pieces. The treating clinician visits the resident’s apartment, and we share the plan with the nurse or wellness director, the agency and the family contact.

Aides who help with bathing and dressing can be told what to watch for on the feet, such as a new dark spot on a toe or a sock that leaves a deep groove, and whom to tell when they see it.

Signs to tell the clinician about

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.

Primary care and overall health

People with arterial or mixed wounds often take a long list of medications: for blood pressure, cholesterol, diabetes, heart rhythm, fluid and pain. Some affect swelling, some affect bleeding at the wound, and pain medicine may need review as the wound changes. Only the prescribing clinician should adjust any of them, which is one reason a current primary care relationship matters.

A primary care visit at home can include a full medication review. Gateway then sends the updated list to the wound care clinician and any vascular office involved, ahead of the next appointment or procedure.

Primary care at home in North St. Louis →

How to get started in North St. Louis

You may already have a surgeon, a wound clinic or a home health nurse and still want help with arterial and mixed wound care closer to home in North St. Louis. That is a fine reason to call 314-325-0126. Tell us who is treating the wound now and what is not working, whether that is the travel, the gaps between appointments or unclear instructions. Gateway does not replace your current clinicians. We can arrange for a partner clinician to see the wound where you live and, with your permission, share notes with the offices already involved so the plans agree.

Have these ready when you call 314-325-0126: the patient’s name, street address and ZIP code, a main phone number and a backup, and the name of any doctor or health center they use. If the patient stays with different relatives during the week, say so. Gateway also arranges care elsewhere in the City of St. Louis, including Downtown and the Central West End, and across the line in Ferguson and North County. Visit availability is confirmed for each address, and a reachable phone number keeps scheduling on track.

  • County: City of St. Louis, Missouri (an independent city)
  • ZIP codes: 63106, 63107, 63113, 63115, 63120, 63147
  • Nearby hospitals: Barnes-Jewish Hospital; SSM Health Saint Louis University Hospital; Christian Hospital in North County (not affiliated with Gateway)
  • Nearby communities: St. Louis City, Downtown St. Louis, Central West End, Ferguson, North County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

More wound care in North St. Louis

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

Common questions

If I see a vascular specialist near North St. Louis, 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 St. Louis.

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.

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.

What if the patient’s phone number changes or they move within North St. Louis?

Call us with the new information as soon as you can. Visits are arranged by address, so a move, even a few blocks, needs to be updated before the next visit. If the patient’s phone is out of service, give us a relative’s or neighbor’s number as a backup. Keeping contact details current is the simplest way to avoid a missed visit.

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.