What to know about arterial and mixed wounds

Over weeks and months, an arterial wound tends to change slowly instead of shrinking steadily the way a wound with a good blood supply does. It may stay the same size, deepen a little, or form a dry, dark cap. Pain often rises and falls with position and time of day.

What happens next usually depends on circulation. If a vascular specialist is able to improve flow, the wound may begin to respond. If not, the goal may shift to keeping it stable, comfortable and free of infection. Mixed wounds add swings in swelling and drainage. Setbacks commonly follow a new bump, a shoe that rubs or a stretch of illness.

How the care plan is built

The first visit is as much about the leg as the wound. The treating clinician feels for pulses at the ankle and on top of the foot, compares the temperature and color of both feet, and checks how quickly color returns to a toe after gentle pressure. The wound is measured, and its base, edges and drainage are described.

Then comes the question that shapes everything else: is there enough arterial flow for this wound to heal? If the answer is unclear, the clinician may order circulation testing before choosing dressings, deciding whether dead tissue should be removed, or allowing any compression.

Local context: South County

People in South County often move between settings without going far: a hospital stay for a vascular procedure, a few weeks in a nearby skilled nursing or rehabilitation center, then home or to a senior living community close by. An arterial wound has to be followed through each move, and orders about compression, dressings and weight on the foot must travel with it. Gateway keeps the wound records and the treating clinician’s current orders together across those handoffs, so each new nursing team starts from the same plan and the family is not left carrying paperwork.

Care settings in South County are varied. Affton and Lemay have small brick bungalows and older two-bedroom homes. Concord, Sappington and Mehlville are known for ranch houses. Oakville and Sunset Hills have newer and larger homes. Throughout the area there are condominiums, senior apartments, assisted living, memory care and many skilled nursing and rehabilitation centers. Gateway arranges partner clinician visits in all of them. We fit the request to the setting, whether that means a kitchen-table visit in Affton or a visit planned with the nursing staff at a facility.

At home between visits

At a home visit, the treating clinician sees things a clinic never shows: the shoes by the door, the chair where you spend the afternoon, the bed where a heel rests all night. For an arterial wound those details matter, because pressure and rubbing on a poorly supplied foot can undo careful dressing work.

Gateway schedules the visit, gathers earlier vascular records and test results beforehand, and sends the clinician’s orders where they need to go afterward. For people whose leg pain limits walking, being seen at home removes the hardest part of getting care, which is the trip.

For residents of nursing and senior living communities

In a skilled nursing facility, partner clinicians see residents with arterial or mixed wounds on site and write recommendations for the attending physician and nursing staff. Facility nurses carry out the daily dressing orders and are well placed to catch change early, since they see the foot every shift.

Gateway coordinates the visit schedule with the director of nursing or wound nurse, sends visit notes for the chart, and tracks open items such as a pending circulation test. Clear documentation of whether compression is ordered for each leg matters here, because staff rotate and a routine wrap on the wrong leg is an avoidable error.

Changes to report

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

Two everyday factors have an outsized effect on arterial wounds: tobacco and movement. Nicotine in any form narrows blood vessels, so clinicians ask about it at nearly every visit, and a primary care clinician can talk through ways to quit when you are ready.

Walking is often encouraged for people with artery disease, yet an open foot wound may change what kind of activity is wise. Primary care and the wound clinician can agree on guidance that fits both. Gateway arranges the two services together so you hear one consistent message about activity, footwear and the goals for the leg.

Primary care at home in South County →

Getting care arranged in South County

Setting up arterial and mixed wound care for someone in South County 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.

South County is a patchwork of small cities and unincorporated neighborhoods, and nearly all of them use St. Louis as the mailing city. When you call, give the ZIP code and a nearby main road so we place the address correctly. Have the patient’s phone number, doctor’s name and insurance cards with you. Gateway arranges care in Affton, Mehlville, Oakville, Crestwood, Sunset Hills and Fenton, among others. If you are helping two relatives in different parts of South County, tell us, and we will take both requests together.

  • County: St. Louis County, Missouri
  • ZIP codes: 63123, 63125, 63126, 63127, 63128, 63129
  • Nearby hospitals: Mercy Hospital South; SSM Health St. Clare Hospital in Fenton; St. Luke's Des Peres Hospital (not affiliated with Gateway)
  • Nearby communities: Affton, Mehlville, Oakville, Crestwood, Sunset Hills, Fenton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

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

Common questions

Can a wound care clinician come to a home in South County to look at an arterial ulcer?

Gateway arranges home visits from partner clinicians for arterial and mixed wounds, and availability is confirmed by location and care setting. Call 314-325-0126 or send a callback request with your name and phone number. We will ask where in South County the patient lives, what kind of home or facility it is, and whether any vascular records exist, then explain what happens next.

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.

If I see a vascular specialist near South County, 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 South County.

Can Gateway arrange in-home visits for someone in South County who uses a wheelchair and cannot manage stairs?

Yes. Limited mobility is one of the main reasons people ask for visits at home. Let us know that the patient uses a wheelchair, which rooms they can reach and whether a caregiver is present. That information goes to the treating clinician before the visit. If the clinician orders equipment or supplies, Gateway coordinates getting them to the South County address.

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.