What to know about non-healing wounds

Anyone can have a wound that stalls, but some people are more likely to. Older adults are seen most often, because skin thins with age and repair slows. People living with diabetes, vein disease, narrowed leg arteries, heart failure or kidney disease are also common, since each condition affects blood flow, swelling or the body’s ability to rebuild tissue.

Limited mobility raises the odds too. Someone who spends most of the day in a wheelchair, recliner or bed puts steady pressure on the same areas. People who have lost feeling in their feet may not notice a shoe rubbing until the skin has broken. People who smoke, people recovering from a long hospital stay and people who are eating very little also turn up often with wounds that will not close.

What an assessment covers

Part of building the plan is agreeing on the goal. For most people the goal is full closure, and the plan is aimed at removing whatever stands in the way. For some, especially people who are very frail or whose circulation cannot be improved, the treating clinician may talk with the patient and family about a different aim: keeping the wound stable, clean, comfortable and free of infection.

Either way, the clinician explains what they found, what they think is holding the wound back and what they recommend. You should come away knowing what the plan is, who does what, and how you will be able to tell whether it is working.

Non-healing wound care in North St. Louis

City living shapes how a stalled wound is cared for in North St. Louis. Dressing boxes left in an apartment lobby can go missing, so we confirm a delivery plan. A walk-up with no elevator affects whether a wheelchair cushion, a knee scooter or a hospital bed is practical, and the clinician plans with that in mind. Many patients here have been seen at more than one hospital system or wound clinic over the years. Gateway gathers those scattered records so the reassessment starts from the full treatment history instead of a guess.

North St. Louis is the common name for the city neighborhoods north of Delmar Boulevard, running up through The Ville, Fairground, Penrose, Walnut Park and Baden to the city limits. Natural Bridge Avenue, North Grand Boulevard, Kingshighway and Interstate 70 are the main routes. These are old neighborhoods with deep family roots, and many elders have lived on the same block most of their lives. The large hospitals are in the central corridor or out in the county, so a wound check or a doctor’s visit often means crossing town. Care at home shortens that distance.

Care at home

Most of the work on a slow wound happens between visits. Dressings are changed on the schedule the clinician ordered, by the patient, a family member or a visiting nurse. Someone keeps an eye on the drainage and the skin around the wound. Leg elevation, pressure relief or wraps are kept up day after day.

Gateway helps keep that routine from breaking down. We ask whether the dressing is manageable, relay questions to the treating clinician and schedule the next visit. If something changes, such as a hospital stay or a new caregiver, tell us so the plan and the visit schedule can be revisited.

Care in skilled nursing and assisted living

For a resident in memory care, a wound that will not heal often has a behavioral side. The person may pull off dressings, scratch at the area, pace for hours on swollen legs, or be unable to say that something hurts. Staff who know the resident usually know these patterns well.

The treating clinician takes that knowledge into account when choosing dressings and how they are secured, and may suggest timing care for the calmest part of the resident’s day. A familiar staff member or relative at the visit helps. Gateway arranges those details ahead of time and updates the family or legal decision-maker afterward.

What to report and when to call 911

Not every change is an emergency, but these deserve a prompt call to the treating clinician’s office:

  • Red streaks running up the arm or leg from the wound
  • Pus, or drainage that turns green, tan or cloudy
  • Home blood sugar readings well above your usual range
  • Numbness, tingling or new swelling below the wound
  • A wound that had closed and has opened again

If you cannot reach the office and you are worried, go to urgent care or an emergency department. Call 911 right away for spurting or uncontrolled bleeding, chest pain or pressure, difficulty breathing, or a limb that suddenly turns cold and discolored.

How primary care fits in

Some people with a long-standing wound have not seen a primary care clinician in a long while. Getting to an office may be the obstacle: stairs, a wheelchair, no ride, or a wound that leaks through its dressing on the way. Meanwhile blood pressure, weight, mood, sleep, tobacco use and mobility go unreviewed, and each has a hand in how skin repairs.

Gateway can arrange primary care in the same settings as wound care, including at home. One coordinated plan means fewer conflicting instructions and one place to call with questions. Each clinician still makes the decisions in their own area.

Primary care at home in North St. Louis →

How to get started in North St. Louis

Clinicians and facility staff referring a patient for non-healing wound care in North St. Louis 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.

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

Other conditions and nearby communities

Read the full guide to non-healing wounds, or see everything Gateway arranges on the mobile wound care in North St. Louis page.

Common questions

Is there someone in North St. Louis who can check a relative’s wound at an assisted living or nursing facility?

Gateway arranges visits in skilled nursing, assisted living, memory care and rehabilitation settings as well as private homes. If your relative lives in a facility in North St. Louis, call us with the facility name. We confirm availability for that location, coordinate with the nursing staff and attending physician, and keep you updated if you are the resident’s contact or decision-maker.

My wound has been treated for months. What would a new clinician do differently?

A reassessment goes back to the cause instead of continuing the same routine. The treating clinician reviews the history, remeasures the wound and looks for barriers that may have been missed, such as pressure, swelling, poor blood flow or a hidden infection. They may order tests or suggest a specialist. Sometimes the plan changes a great deal, and sometimes only one piece does.

Can a wound that has been open for years still heal?

Sometimes, and it is worth asking. The length of time alone does not rule out improvement. What matters is whether the things holding the wound back can be found and changed. Some long-standing wounds do close after the cause is addressed. Others cannot fully heal, and the aim becomes comfort and preventing infection. The treating clinician can give you an honest view after an assessment.

Do I need a doctor’s referral to ask for wound care in North St. Louis?

No. Patients, relatives and caregivers in North St. Louis can call Gateway directly at 314-325-0126 without a referral. Doctors, hospitals and facilities can also refer. If records or orders are needed, we request them with permission. The treating clinician decides what care is appropriate after assessing the patient. Whether a health plan requires a referral or authorization depends on the plan, and you can ask about that when you call.

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.