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 an assessment covers
Lymphedema wound care is built in stages, and the plan is expected to change. Early on, the focus is on reducing the swelling and controlling drainage, and wraps may need frequent adjustment as the limb shrinks and they loosen. At each visit the treating clinician measures the wound, and often the limb itself, and compares the numbers with earlier visits.
When the limb size has settled, attention turns to maintenance. That may mean fitting a garment for daily wear and deciding whether a lymphedema therapist should be involved. If the measurements stop improving, the clinician looks again at the cause, the fit of the compression and what is happening between visits.
Local context: O’Fallon, Missouri
In many households in O’Fallon, the family member who helps with wraps leaves early for work and gets home late. That leaves a long stretch when a wrap that slips or a dressing that soaks through has no one to fix it. Tell the treating clinician about the household schedule. Orders can sometimes be built around it, and home health nursing during the day may be an option. If your relative lives in one of the newer senior living communities, Gateway coordinates with the staff there as well.
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.
When care happens at home
Most of the work on a lymphedema wound happens between visits. The treating clinician leaves instructions for the days in between, and they usually cover washing and thoroughly drying the skin, using a moisturizer if one is ordered, keeping wraps or garments on as directed and resting with the limb raised.
Wraps slip, dressings soak through and questions come up. Ask at the visit whom to call when that happens and what to do in the meantime, so no one is left guessing on a weekend. If part of the routine is not working, say so. A plan can be adjusted, but only if the clinician hears about the problem.
In a facility
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
Small changes in the skin of a limb with lymphedema are worth reporting early, while they are easier to deal with. Let the treating clinician know about:
- A wound that is getting larger or deeper
- A clear increase in leaking, or dressings that soak through faster than before
- New blisters, raw patches or cracks, especially in skin folds
- Skin around the wound that turns white, soggy or sore
- Itching, scaling or splits between the toes
- A new or stronger odor
Call 911 for heavy bleeding that does not stop with firm pressure, or if the person becomes confused or hard to wake.
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.
Getting care arranged in O’Fallon
Before anything is scheduled, Gateway checks two things for every request for wound care with lymphedema in O’Fallon: whether a partner clinician serves that address and care setting, and what the patient’s plan requires from the treating provider. Neither is assumed. If both line up, we arrange the visit and gather records. If something stands in the way, we say so, and our guide to following up on a request explains what to ask next. Gateway coordinates the care and does not make clinical decisions. Those belong to the treating clinician who sees the wound. Start by calling 314-325-0126, or ask a family member to call for you.
Progress West Hospital is in O’Fallon itself. Barnes-Jewish St. Peters Hospital is to the east, and SSM Health St. Joseph Hospital in Lake Saint Louis is to the west. Gateway is not affiliated with any of the three, and patients from all of them come home to O’Fallon addresses. A daughter or spouse can call us from the hospital room to ask about follow-up. Case managers can send a referral with the discharge summary and wound orders. Gateway then checks partner clinician availability for that part of O’Fallon and reports back.
- 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 wounds with lymphedema, or see everything Gateway arranges on the mobile wound care in O'Fallon page.
- Diabetic foot ulcers
- Venous leg 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
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Wound care with lymphedema in St. Peters
- Wound care with lymphedema in Lake St. Louis
- Wound care with lymphedema in Wentzville
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.
Why do I keep getting cellulitis in the same leg?
A limb with lymphedema clears bacteria slowly, so germs that get in through a crack, a blister or peeling skin between the toes can take hold quickly. Each infection can scar more lymph vessels, which adds swelling and sets up the next one. Tell your clinicians how often it has happened. They can look for the entry points and decide what prevention makes sense for you.
Why does the skin on my swollen leg look thick and bumpy?
When protein-rich lymph fluid sits in the tissue for months or years, the skin responds by thickening and hardening. It may form deep creases at the ankle or grow small wart-like bumps, especially on the feet and toes. These changes are a sign of long-standing lymphedema. They make skin harder to keep clean and more likely to crack, so point them out to the treating clinician.
My mother just moved into my O’Fallon home from out of state. Can Gateway help her get care started?
You can ask. Gateway arranges primary care and wound care visits with partner clinicians at home, which can be useful while your mother settles in. With her permission, we request records from the doctors she saw before the move. Have her medication list and insurance cards ready when you call. Coverage depends on her plan, the treating provider and the care needed.
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.