What to know about wounds with lymphedema

People whose swelling has been present for a long time are the ones most likely to develop a lymphedema wound. That includes people who had lymph nodes removed or treated with radiation for cancer, people with long-standing vein disease in the legs, and people who have had skin infections in the same limb more than once. Severe obesity can overload the lymphatic system. So can spending most of the day seated with the legs down, which is common after a stroke, with advanced arthritis, or with heart and lung conditions that limit walking.

A smaller group is born with lymph vessels that did not form normally, and their swelling may begin in childhood or early adulthood. Older adults often have several of these causes at once.

What the treating clinician looks at

A first assessment usually starts with the story of the swelling. The treating clinician asks when it began, whether it affects one limb or both, and whether it goes down overnight. A history of cancer treatment, leg surgery, injuries, blood clots or repeated skin infections matters, and so does the list of current medicines.

This history points to the cause, or more often the mix of causes, and that shapes the care plan. Swelling driven mostly by the lymphatic system is handled differently from swelling driven by the heart, the kidneys or the veins. The clinician may want records or test results from other offices, and Gateway gathers those ahead of the visit when it can.

Arranging this care in Oakville

Many people in Oakville have lived in the same house for decades and have managed swollen legs on their own for nearly as long, often with worn stockings and a routine that worked until the skin opened. Older homes add their own difficulties: a tub to step over when legs need washing, a bathroom up the stairs, a favorite chair with no way to raise the feet. A treating clinician visiting at home can see these and suggest workable changes. Gateway coordinates the visit and any garments or supplies ordered.

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

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.

For residents of nursing and senior living communities

Memory care and assisted living bring their own challenges for lymphedema. A resident with dementia may pull at a wrap, unroll it or be unable to say that it hurts, so staff need to know what to watch for: toes changing color, a wrap bunched behind the knee, fluid soaking through. The treating clinician takes this into account when choosing the type of compression.

Assisted living staff are often not permitted to change dressings or apply wraps. In that case the clinician may order home health nursing to come to the apartment, and Gateway coordinates among the agency, the community and the family.

Signs to tell the clinician about

Changes in the swelling itself can point to something beyond the wound. Tell the treating clinician about:

  • Swelling that increases quickly over a day or two
  • Swelling that moves higher, into the thigh, groin or belly
  • Rapid weight gain, or shoes and garments that suddenly do not fit
  • Needing extra pillows to breathe comfortably at night

Sudden swelling and pain in one leg, often with warmth in the calf, needs urgent medical evaluation because it may be a blood clot. Call 911 for chest pain, trouble breathing, coughing up blood, fainting, or a racing heartbeat with lightheadedness.

How primary care fits in

Lymph flow in the legs gets much of its push from the calf and foot muscles squeezing with each step, so anything that limits walking tends to worsen swelling. Primary care can look at what is holding a person back, whether that is joint pain, breathlessness, weakness or fear of falling, and whether therapy would help.

General health affects the wound as well. Healing draws on protein and calories, high blood sugar slows repair and raises infection risk, and extra body weight adds pressure on lymph vessels in the groin and legs. These are long-term concerns that a primary care clinician follows alongside the wound visits.

Primary care at home in Oakville →

Getting care arranged in Oakville

For a resident of a nursing home, assisted living or memory care community in Oakville, a request for wound care with lymphedema can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

When someone from Oakville needs a hospital, it is usually Mercy Hospital South, a short drive north. Gateway is not affiliated with the hospital. Coming home with a new surgical incision, a pressure injury or a leg wound raises a simple question: who is going to look at this next? Families can call Gateway to ask about follow-up visits at the Oakville address. Discharge planners can refer by phone or by fax to 314-786-7966. Once the summary and orders arrive, we confirm a partner clinician’s availability and let the family know.

  • 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

Other conditions and nearby communities

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

Common questions

Do I need a referral to request lymphedema wound care in Oakville?

No. Patients, family members and caregivers can call Gateway directly at 314-325-0126 or send a callback request, with or without a referral. Some health plans have their own referral or authorization rules, and we ask about those when we confirm the treating provider. The web form asks only for a name and phone number, so please save medical details for the phone call.

What shoes can I wear over compression wraps?

Wraps add bulk, and many regular shoes will not fit over them. Forcing a foot into a tight shoe can rub the skin or change how the compression sits, and walking in loose slippers raises the risk of a fall. Tell the treating clinician if you cannot get footwear on. Adjustable shoes or other options may be suggested, and the plan can sometimes be changed to make walking safer.

Should I rest with my leg raised or try to keep moving?

Usually both have a place. Raising the limb while resting lets gravity help fluid drain, and walking or moving the ankles works the muscles that push lymph along. Long hours sitting still with the feet on the floor tend to make swelling worse. The right balance depends on your heart, your steadiness on your feet and your wound, so ask the treating clinician what is safe for you.

My father lives in a lower-level apartment in our Oakville home. Can he be seen there?

Yes. That is a common arrangement in Oakville. Tell us which door leads to his space and whether there are steps from the driveway. The treating clinician sees him where he is comfortable, and with his permission you can be present to hear the plan. Gateway then coordinates any supplies or follow-up the clinician orders.

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.