Understanding arterial and mixed wounds

Several common beliefs about leg wounds do not hold for arterial and mixed wounds. One is that every leg sore should be wrapped tightly, when firm wrapping on a leg with poor arterial flow can do harm. Another is that propping the feet up always helps. With artery disease, raising the legs can make pain worse, so the right position is something to ask the clinician about.

People also assume that a small, dry wound is a minor one, or that foot pain at night is just age or arthritis. And many expect the right dressing to fix the problem, when the blood supply usually matters more than anything placed on the wound.

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.

Arranging this care in Oakville

Many homes in Oakville were built with the bedrooms upstairs, and people with arterial pain often end up sleeping in a recliner on the main floor with their feet down. That eases the ache but can bring swelling and leave a heel pressed against a footrest for hours. A treating clinician who visits the home can see the setup and adjust the plan for heel protection and positioning. Gateway arranges those visits for long-time residents who want to stay in the houses they know, and coordinates supplies so protective padding and dressings are delivered there.

Oakville is mostly single-family subdivisions: ranch homes, two-story houses, and newer villas and condominiums that attract people who are downsizing. Walkout basements are common, and some older adults live in a lower-level suite in a son’s or daughter’s house. Assisted living, memory care and skilled nursing communities are found in Oakville and just north in Mehlville. Gateway arranges partner clinician visits in each setting and asks practical questions first, such as which level the patient lives on and who will answer the door.

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

Many people arrive at a rehabilitation center after a hospital stay for a vascular procedure, an infection or a toe amputation, with a wound that still needs close follow-up. Therapy adds a complication: the foot has to bear weight and wear a shoe again.

The treating clinician works with facility nursing and therapists on how the wound is protected during sessions, and with the attending physician on orders. Gateway obtains the hospital’s operative and vascular reports, lines up any follow-up visit the surgeon requested, and plans how wound care will continue at home or in long-term care after discharge.

What to report and when to call 911

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 Oakville →

How to get started in Oakville

If you have been managing a wound mostly on your own and are looking for arterial and mixed wound care in Oakville, you can call Gateway yourself at 314-325-0126. Tell us what the wound looks like now, what the last clinician said about it and what is getting harder to manage. It helps to know the patient’s insurance and the names of the doctors involved, but do not wait until you have everything. We check whether a partner clinician can see the patient at home or in their facility, and we tell you what we find. The treating clinician takes it from there, and you stay part of the conversation.

Call 314-325-0126 with the patient’s Oakville address, phone number, date of birth and doctor’s name, and tell us about any recent hospital or rehabilitation stay. Mailing addresses here say St. Louis, so mention Oakville or the 63129 ZIP code. Gateway also arranges care in Mehlville, the rest of South County, and across the Meramec River in Arnold and Imperial. Oakville is tucked between two rivers, with only a few roads in and out, so visit days are confirmed by location.

  • County: St. Louis County, Missouri
  • ZIP codes: 63129
  • Nearby hospitals: Mercy Hospital South (not affiliated with Gateway)
  • Nearby communities: Mehlville, Arnold, South County, Imperial
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in Oakville

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

Common questions

If I see a vascular specialist near Oakville, 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 Oakville.

What is an ankle-brachial index, and does it hurt?

It is a common circulation test. Blood pressure cuffs are placed on the arms and ankles, and a small handheld ultrasound device listens to the pulse while each cuff is inflated. Comparing ankle and arm pressures shows whether blood flow to the foot is reduced. The cuff squeeze can be uncomfortable for a moment, especially near a sore area, so tell the person doing the test where your wound is.

Why should I be careful with a heating pad or warm soak when my feet feel cold?

Feet with poor circulation often have reduced feeling as well, and skin that cannot sense heat or carry it away can burn at temperatures that seem mild. A burn on a poorly supplied foot becomes another wound to manage. Clinicians commonly suggest loose warm socks and blankets instead, and advise against soaking a foot with an open wound unless they have ordered it. Ask the treating clinician before using direct heat.

Can I use the website form to describe my wife’s wound and give our Oakville address?

Please use the form for contact details only: your name and phone number. Do not enter medical details there. Someone from Gateway will call you back, and you can describe your wife’s situation and give the Oakville address by phone. If you would rather talk now, call 314-325-0126. For anything that looks like an emergency, call 911 instead.

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.