Wound care with lymphedema in North St. Louis.

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 the treating clinician looks at

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.

Arranging this care in North St. Louis

Large medical centers, cancer programs and lymphedema therapy clinics are often a short distance from North St. Louis. Getting to them is another matter when a leg is leaking through its dressing. Parking garages, long corridors and waiting rooms can mean an hour or more with the limb down. Gateway arranges wound visits where you live and coordinates records with the specialists you already see. Tell us how package delivery works in your building, so boxes of absorbent dressings and wrap supplies reach you and not just the lobby.

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.

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.

In a facility

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.

Changes to report

Skin infection is the complication to watch most closely with lymphedema, because it can spread through a swollen limb quickly. Contact the treating clinician promptly if you notice:

• Redness that is new or spreading, or red streaks running up the limb
• Skin that feels hot or newly tender
• Fever, chills or body aches
• Drainage that turns cloudy, thick or foul smelling
• Pain that is clearly worse than usual

Do not wait for the next scheduled visit to mention these. Call 911 if a person with these signs becomes confused, faint, very drowsy or short of breath.

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 North St. Louis →

Getting care arranged in North St. Louis

People asking about wound care with lymphedema in North St. Louis usually want to know what the first visit involves. Before it, Gateway collects the records the treating clinician asks for and confirms the time and place with you. During it, the clinician looks at the wound and the skin around it, measures it, asks about your health and medications and explains what they recommend. Afterward, the orders go to whoever does the daily care, supplies are requested and a follow-up is planned. Our guide to how mobile wound care visits work has more. To begin, call 314-325-0126. Whether a visit can be arranged is confirmed for your location.

For hospital care, people in North St. Louis commonly go to Barnes-Jewish Hospital, SSM Health Saint Louis University Hospital or Christian Hospital in North County. Gateway has no affiliation with any of them. A patient may be sent home with dressing instructions and a follow-up appointment that is hard to get to. Families can call us to ask whether wound care or primary care visits can be arranged at home. Discharge planners and social workers can refer by phone or fax, and should include the discharge summary, the orders and a working phone number for the patient or a relative.

• 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

Related care in North St. Louis

Read the full guide to wounds with lymphedema, or see everything Gateway arranges on the mobile wound care in North St. Louis 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 the City of St. Louis
• Wound care with lymphedema in Downtown St. Louis
• Wound care with lymphedema in the Central West End
• Wound care with lymphedema in Ferguson

Common questions