What to know about venous leg ulcers
Leg veins have to push blood uphill. They rely on two helpers: one-way valves inside the vein, and the calf muscle, which squeezes the veins with every step. When valves wear out or are damaged by an old blood clot, blood slips backward and collects near the ankle. Pressure in those veins stays high whenever you sit or stand.
That pressure forces fluid and blood cells out into the tissue, which swells, stiffens and receives less oxygen and nourishment than healthy skin. Skin in that state is easy to injure and slow to mend. A scrape from a walker, an insect bite or scratching an itchy patch can be enough to start an ulcer.
What an assessment covers
The history shapes a venous ulcer plan as much as the exam does. The treating clinician asks how long the ulcer has been open, whether this leg has ulcerated before, and whether you have had a blood clot, a vein procedure, leg surgery or an injury. Allergies are reviewed, along with any skin reaction to past dressings, tapes or wraps, so the same products are not ordered again.
The clinician also asks what you have already tried and what happened. An ulcer that does not look or behave like a typical venous wound, or one that fails to respond, may lead to more tests or a referral to a vascular or skin specialist.
Arranging this care in North St. Louis
Many people in North St. Louis with a venous leg ulcer already have a vascular or vein specialist at one of the large medical centers nearby. The difficulty is the weekly work in between: wrap changes, drainage checks and skin care that are hard to reach by bus, ride service or a long walk from a parking garage. Gateway can arrange for a partner clinician to provide that routine care at home, and we send visit notes to the specialist’s office so the two stay aligned. If vascular testing is ordered, we help schedule it and arrange transportation.
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
Family caregivers often carry part of the work for a venous leg ulcer at home. Depending on the orders, that might mean helping with a stocking or adjustable garment, changing an outer dressing, propping the legs at rest, or watching the toes and skin for changes. No one should have to guess. The treating clinician can show a caregiver which tasks are theirs and which to leave alone, and Gateway can request visit times when the caregiver is able to be there. If the caregiver works, travels or lives elsewhere, tell us, and with your permission we will keep them informed by phone.
In a facility
In a skilled nursing facility, venous leg ulcer care is shared work. The partner clinician sees the resident on site, assesses the ulcer and the circulation, and writes or recommends orders in line with the facility’s process. Nursing staff carry out dressing changes and compression between visits and document what they see. Gateway keeps the two connected by scheduling rounds with the facility, sending visit notes and following up on open questions. The attending physician stays informed and remains in charge of the resident’s overall medical care, including the heart, kidney and medication issues that affect leg swelling.
Changes to report
Venous leg ulcers can become infected, and infection in the skin of the leg can spread. Report these changes to the treating clinician promptly:
- Redness, warmth or swelling that is spreading beyond the ulcer
- Pain that is getting worse instead of better
- Thick, cloudy or foul-smelling drainage
- Fever, chills or feeling generally unwell
- An ulcer that is suddenly larger or deeper
Call 911 for chest pain, shortness of breath, confusion or fainting, or bleeding from the leg that does not stop with firm, steady pressure.
How primary care fits in
Not all leg swelling comes from the veins. The heart, kidneys, liver and thyroid can each cause fluid to build up, and so can certain medicines for blood pressure, pain or diabetes. Sorting out which causes apply is primary care work, usually involving an exam, a medication review and sometimes blood tests or heart testing. That information changes wound care. A clinician planning compression wants to know, for example, whether heart failure is present and how stable it is. When Gateway arranges wound care and primary care together, findings move in both directions and the leg is not handled as if it were separate from the person.
Arranging venous leg ulcer care in North St. Louis
To arrange venous leg ulcer care in North St. Louis, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.
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
More wound care in North St. Louis
Read the full guide to venous leg ulcers, or see everything Gateway arranges on the mobile wound care in North St. Louis page.
- Diabetic foot 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
- Wounds with lymphedema
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Venous leg ulcer care in the City of St. Louis
- Venous leg ulcer care in Downtown St. Louis
- Venous leg ulcer care in the Central West End
- Venous leg ulcer care in Ferguson
Common questions
My mother lives in a nursing home in North St. Louis. Can Gateway arrange venous ulcer care there?
Often, yes. Partner clinicians see residents in skilled nursing, assisted living, memory care and rehabilitation settings, working alongside the facility’s nurses and the attending physician. Start by telling us the facility’s name, or ask its nursing staff to contact Gateway. We confirm whether visits are available at that location and what the facility needs in order to begin.
Could a leg ulcer that will not heal be something other than a venous ulcer?
Yes. Poor arterial circulation, diabetes, pressure, inflammatory conditions, certain infections and, rarely, skin cancer can all cause leg wounds that resemble venous ulcers. That is one reason the clinician reassesses an ulcer that is not responding as expected. Further circulation testing, lab work, a tissue sample or a specialist referral may be ordered. Raise the question directly if you are worried.
Can I shower or bathe with a compression wrap on?
Most wraps need to stay dry, because a wet wrap can irritate skin and lose its hold. How you bathe depends on the type of compression ordered. Some garments come off for bathing, while layered wraps usually stay on until the next change. Ask the treating clinician what applies to you and which cover, if any, they suggest. Report a wrap that gets wet.
My grandmother lives in a senior apartment building in North St. Louis. Can a clinician see her there?
Yes, visits can be arranged in senior apartment buildings. Give us the building’s street address, her apartment number and how visitors get in, such as a front desk or buzzer. Let her know someone will be calling so she expects it. Gateway confirms availability for her location, and you or she will be contacted about the visit day before anyone comes.
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.