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

Beyond the wound itself, the treating clinician gathers the history that explains it. Expect questions about:

  • How the wound started and how long it has been open
  • Pain: where, when, and what eases it
  • How far you can walk before your calves or feet hurt
  • Tobacco use, diabetes and past heart or vascular procedures
  • Shoes, slippers and whether you sleep in a bed or a recliner

The answers feed a plan with clear goals. For some people the aim is closure once circulation improves. For others, particularly when a procedure is not an option, the aim is comfort, protection and preventing infection.

Arranging this care in South St. Louis

Large medical centers with vascular labs and specialists are usually a short trip from South St. Louis, which helps when the treating clinician orders circulation testing. The hard part tends to be the last hundred feet: steep front steps on an older multi-story home, a narrow staircase, a long walk from the drop-off. Gateway coordinates the appointment, sends the wound records ahead and returns the results to the wound care team. At home, the clinician can look at how you manage the stairs and whether your footwear protects the wound on the way.

Brick defines the south side. There are bungalows and gingerbread-style houses in St. Louis Hills, narrow shotgun homes on The Hill, row houses in Soulard, and two-family and four-family flats nearly everywhere. Front steps are steep, gangways are narrow and parking is on the street. Senior apartment buildings, assisted living and skilled nursing facilities are spread through the neighborhoods as well. Gateway arranges partner clinician visits in each setting. Tell us if the patient lives in an upstairs flat or needs help getting to the door, so the visit is planned with that in mind.

Care at home

Family caregivers are often the first to notice trouble with an arterial wound, because they see the foot every day. The treating clinician can show a spouse, adult child or paid aide what the wound should look like, how the dressing is handled under the current orders, and which changes call for a phone call.

Caregivers also help in quieter ways: checking that socks and shoes are not leaving marks, keeping walkways clear so toes are not stubbed, and making sure bedding is not pressing on sore toes at night. Gateway can include a caregiver on scheduling calls and updates when the patient agrees.

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.

What to report and when to call 911

For a mixed wound, watch both the swelling and the circulation. Report these to the treating clinician:

  • Swelling that rises quickly or spreads up the leg
  • Toes that turn pale, blue or numb, or new pain, while a wrap or stocking is on
  • Drainage soaking through dressings sooner than before
  • New blisters or breaks in the skin near the wound
  • Fever, chills or feeling unwell

Call 911 for a leg that suddenly becomes cold, white or blue and very painful, for chest pain or trouble breathing, or for signs of stroke such as a drooping face, weakness in one arm or slurred speech.

Why primary care matters here

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 St. Louis →

How to get started in South St. Louis

People asking about arterial and mixed wound care in South St. Louis usually want to know what the first visit involves. Before it, Gateway collects the records the treating clinician asks for and confirms the time and place with you. During it, the clinician looks at the wound and the skin around it, measures it, asks about your health and medications and explains what they recommend. Afterward, the orders go to whoever does the daily care, supplies are requested and a follow-up is planned. Our guide to how mobile wound care visits work has more. To begin, call 314-325-0126. Whether a visit can be arranged is confirmed for your location.

When you call, name the neighborhood as well as the address, since South St. Louis covers a lot of ground and several ZIP codes. Tell us about stairs, a locked gate or a doorbell that does not work, and give a phone number that will be answered. Gateway also arranges care in Downtown St. Louis, the Central West End and the rest of the city, and in nearby Affton, Shrewsbury and Maplewood. Street parking and one-way blocks are part of visiting here, and visit days are confirmed by location.

  • County: City of St. Louis, Missouri (an independent city)
  • ZIP codes: 63104, 63109, 63111, 63116, 63118, 63139
  • Nearby hospitals: SSM Health Saint Louis University Hospital; Barnes-Jewish Hospital; SSM Health St. Mary's Hospital in Richmond Heights; Mercy Hospital South (not affiliated with Gateway)
  • Nearby communities: St. Louis City, Downtown St. Louis, Affton, Shrewsbury, Maplewood, Central West End
  • 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 St. Louis page.

Common questions

My father lives in a nursing facility in South St. Louis. Can his arterial wound be seen there?

Partner clinicians see residents in skilled nursing, assisted living, memory care and rehabilitation settings, working with the attending physician and nursing staff. Whether visits are available at a particular facility in South St. Louis is confirmed first. A family member can call Gateway, or the facility’s nursing team can send a referral. With permission from the resident or their representative, we keep the family contact updated.

How can one wound be both arterial and venous?

The legs have two sets of vessels. Arteries carry blood down to the foot and veins carry it back up. Many older adults have disease in both. When weak veins cause swelling and skin breakdown on a leg where the arteries are also narrowed, the result is a mixed wound. It often looks like a venous ulcer, which is why clinicians check arterial flow before treating it as one.

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.

Does Gateway help with dressing supplies for patients in South St. Louis?

When the treating clinician orders dressings or other supplies, Gateway coordinates getting them to the patient’s home or facility in South St. Louis. Which supplies are ordered is a clinical decision, and whether a plan pays for them depends on the plan, the treating provider and the care needed. Tell us if supplies from the hospital are running low so the clinician’s office knows before the visit.

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.