Understanding wounds with lymphedema

Lymphedema is long-term swelling that builds when the lymphatic system cannot carry fluid out of an arm or leg as fast as it collects. The lymphatic system is a network of thin vessels and nodes that returns fluid to the bloodstream and helps the body fight infection. When it falls behind, fluid that is rich in protein settles in the tissue under the skin.

A lymphedema wound is any open area on a limb swollen this way. It may be a shallow raw patch, a blister that has burst, a split at the bottom of a skin fold or a deeper ulcer. Most are on the lower legs, ankles and feet. What they share is the setting: skin that is stretched, damp and slow to repair itself.

How the care plan is built

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 O’Fallon

Crossing the river for a lymphedema therapy appointment can take a large part of a day from O’Fallon, with the leg down for the whole ride. Many people would rather have wound care come to them. Before a visit is scheduled, Gateway confirms two things: the treating provider who serves your address, and how that provider works with your coverage, whether that is Medicare, an Illinois Medicaid plan or a commercial plan. Participation and benefits depend on the provider, the plan and the care needed.

Newer single-family homes make up much of O’Fallon, joined by older houses near downtown, townhomes, apartments and communities built for older adults. Assisted living, memory care and skilled nursing are available in and near the city. Gateway arranges visits with partner clinicians in all of these settings. When relatives are helping from a distance, we can plan the visit with them by phone and keep them posted. When the patient lives in a facility, we coordinate with the staff so the treating clinician can review the chart and leave clear orders.

At home between visits

A home visit lets the treating clinician see the limb in the place where the swelling actually builds. The chair you spend the day in, the height of your bed and whether you have any way to prop up your legs all affect how much fluid collects. Those details are hard to describe in an office and easy to see in a living room.

It also spares you the trip. Moving a heavy, wrapped, draining leg into a car and through a waiting room is exhausting, and some people put off care because of it. Gateway arranges visits with partner clinicians in private homes, with availability confirmed by location.

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

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

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 O'Fallon →

Arranging wound care with lymphedema in O’Fallon

Setting up wound care with lymphedema for someone in O’Fallon usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. We follow up on supplies, the next visit and communication with your other clinicians.

You do not need a confirmed diagnosis to start.

HSHS St. Elizabeth’s Hospital is here in O’Fallon, and Memorial Hospital Shiloh is just over the city line. Gateway is not affiliated with either one. With two hospitals this close, the ride home after a stay is short, but the questions about what happens next are the same as anywhere. A relative can call us before discharge day to ask about follow-up, and discharge planners can refer by phone or fax. We request the summary and orders, confirm whether the patient is going home or to a facility, and arrange a visit with a partner clinician.

Other conditions and nearby communities

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

Common questions

Can a wound care clinician come to a home in O’Fallon for a lymphedema wound?

Gateway arranges home visits with partner clinicians across Greater St. Louis and the Metro East, and availability in O’Fallon is confirmed by address and care setting. Call 314-325-0126 to ask. It helps to have a list of your medicines, the names of the clinicians you see and any wraps or garments you have tried. The treating clinician decides what care is needed after seeing the limb.

Can I shower with a lymphedema wound and compression wraps?

Ask the treating clinician, because the answer depends on the dressing and the type of compression. Some wraps are meant to stay on and stay dry for several days, while others come off daily. Clean skin matters a great deal with lymphedema, so the clinician will explain how washing fits into your routine and how to protect anything that must not get wet.

What does a lymphedema therapist do, and would I still need wound care?

A lymphedema therapist is a physical or occupational therapist with added training in reducing lymphatic swelling through specialized massage, bandaging, exercise and garment fitting. A therapist does not replace the clinician who manages an open wound. The two often work on the same limb at different stages. The treating clinician decides whether and when a therapy referral makes sense, and Gateway can coordinate the referral paperwork.

I live close to HSHS St. Elizabeth’s Hospital in O’Fallon. Why would I need visits at home?

Living near a hospital does not make it easier to leave the house. Getting dressed, into a car and through a parking lot is hard with a painful wound, a walker or a caregiver who works. Hospitals focus on urgent and inpatient needs, while ongoing wound checks and routine follow-up can often be done where you live. The treating clinician will tell you if you need hospital or outpatient care.

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.