Understanding arterial and mixed wounds

Arterial and mixed wounds mostly affect older adults whose blood vessels have been under strain for decades. The people clinicians see most often include those who smoke or used to, people with diabetes, and people with high blood pressure, high cholesterol or chronic kidney disease, including those on dialysis. Many have already had a heart attack, a stroke, or a stent or bypass in a leg. Calf cramping that comes on with walking and eases with rest is a common earlier clue.

Mixed wounds tend to appear in people with a long history of leg swelling, varicose veins or a past venous ulcer who later develop artery disease on top of it.

How the care plan is built

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 O’Fallon

From O’Fallon, a vascular lab or specialist office can be a long drive, and for someone with a painful foot wound every trip counts. Gateway works to make each one worth it by confirming ahead of time that the referral, the wound records and any test orders have reached the office. Where the offices allow it, testing and the specialist visit are requested for a single trip. Routine wound checks happen at home, so the long drives are saved for the visits only a vascular office can provide.

Two-story houses with the bedrooms upstairs are the norm in many O’Fallon subdivisions, which can be a problem after surgery or when a leg wound makes stairs risky. The city also has ranch-style villas, apartments, and a growing number of senior living, assisted living, memory care and skilled nursing communities. Gateway arranges partner clinician visits in all of these. For a house, we ask whether the patient is staying on the main floor. For a senior community, we coordinate with the wellness or nursing staff so they receive the treating clinician’s orders.

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.

In a facility

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

A daily look at both feet catches many problems early. Tell the treating clinician about:

  • A new sore, blister or dark spot on a toe, heel or ankle
  • One foot that feels noticeably cooler than the other
  • Foot pain when lying flat that eases when you hang the foot over the edge of the bed
  • Skin around the wound turning red, shiny or tight
  • A dressing with a new smell or a new color of drainage

Do not wait for the next scheduled visit to mention these. Call 911 if the foot or leg abruptly goes cold, numb and discolored, or if you cannot move it.

How primary care fits in

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 O'Fallon →

Arranging arterial and mixed wound care in O’Fallon

If you have been managing a wound mostly on your own and are looking for arterial and mixed wound care in O’Fallon, 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.

Say O’Fallon, Missouri when you call or leave a message, because there is also an O’Fallon in Illinois, and the region Gateway covers includes the Metro East. Give the street address, the ZIP code (63366 or 63368), a phone number and the name of the regular doctor. Gateway also arranges care in St. Peters, Lake St. Louis, Wentzville, Dardenne Prairie and Cottleville. O’Fallon is large, so the specific address matters when visit days are confirmed with a partner clinician.

  • County: St. Charles County, Missouri
  • ZIP codes: 63366, 63368
  • Nearby hospitals: Progress West Hospital in O'Fallon; Barnes-Jewish St. Peters Hospital; SSM Health St. Joseph Hospital in Lake Saint Louis (not affiliated with Gateway)
  • Nearby communities: St. Peters, Lake St. Louis, Wentzville, Dardenne Prairie, Cottleville
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in O’Fallon

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

Common questions

If I see a vascular specialist near O’Fallon, 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 O’Fallon.

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.

What should I have ready before the first visit for an arterial or mixed wound?

Helpful items include a current medication list, the names of your primary care clinician and any vascular or heart specialists, and results of past circulation tests or leg procedures if you have them. Set out the shoes and slippers you wear most. Write down when the wound started and when pain is worst. Gateway can request outside records for the treating clinician, so missing paperwork is no reason to delay calling.

What happens after I request wound care for someone in O’Fallon?

Someone from Gateway calls to collect the basics: the patient’s name, address, phone number, doctors and recent hospital stays. With permission, we request records and current orders. We then contact a partner clinician who sees patients in O’Fallon and confirm availability. You hear back with the next step. After the first visit, we coordinate any supplies or follow-up the treating 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.