Skin tear and traumatic wound care in South St. Louis.

What to know about skin tears and traumatic wounds

Skin tears are seen most often in the oldest adults, but age is only part of the picture. The risk climbs for anyone who needs hands-on help to bathe, dress or move from bed to chair, because every assist puts force on the skin. It climbs again for people with memory loss, poor eyesight or unsteady balance, who bump into things and may not mention it. Swollen legs, a poor appetite and low fluid intake add to it, as do certain long-term medicines. One of the clearest warnings is a previous skin tear, since the conditions that caused the first are usually still there. Younger adults are not exempt. Serious illness and long hospital stays can leave skin just as fragile.

What the treating clinician looks at

For any injury below the knee, the treating clinician examines the leg, not only the wound. Pulses at the foot and ankle, skin temperature and color, and hair and nail growth give clues about blood flowing in. Swelling, brownish staining around the ankle and bulging veins give clues about blood flowing back out. Both matter, because a shin wound on a swollen or poorly supplied leg behaves like a leg ulcer in the making. If the findings raise questions, the clinician may order circulation testing before deciding how swelling should be managed. The care plan then covers the leg as a whole: protecting the wound, controlling fluid, and guarding the shin against the next knock.

Arranging this care in South St. Louis

City housing has its own ways of tearing skin: narrow hallways, tight bathrooms, radiators, steep stairs and furniture packed close together. In South St. Louis, many older adults live in apartments or multi-story homes where a trip to a wound clinic means stairs on an unsteady leg and a long walk from wherever the car is parked. Bringing the clinician to the door removes that risk. When we schedule, we ask about buzzers, front desks, elevators and parking so the clinician is not left waiting outside, and we coordinate dressing supplies to reach the right unit, not just the lobby.

South St. Louis means the city neighborhoods generally along and south of Interstate 44: Tower Grove, Dutchtown, Carondelet, The Hill, Soulard, St. Louis Hills and many more, each with its own corner shops, churches and parks. Grand Boulevard, Gravois Avenue, Kingshighway and Hampton Avenue carry the traffic, and Tower Grove Park and Carondelet Park anchor the map. People here are loyal to their blocks. An older resident may have lived within a mile of the same parish all their life, and care at home lets that continue when getting out becomes difficult.

Care at home

Some people with a traumatic wound already have a home health agency coming in, or qualify for one after a hospital stay. In that case the treating clinician’s orders go to the agency nurses who do the dressing changes, and Gateway keeps the two sides in step: shared notes, updated orders, and one plan instead of two. Supplies are handled the same way. The clinician orders the dressings and wraps the wound needs, and we coordinate getting them to the house so nobody is improvising from the medicine cabinet. Whether home health or particular supplies are covered depends on the plan and the provider.

Care in skilled nursing and assisted living

In a skilled nursing facility, a skin tear is usually found by an aide or nurse during morning care or after a transfer. The facility documents it, notifies the attending physician and the family, and can refer to Gateway for a wound care visit. The treating clinician assesses the resident at the bedside and writes orders that facility nurses carry out between visits. Findings go back to the attending physician, the director of nursing and the wound nurse, so the chart tells one consistent story. Because many tears happen during bathing, dressing and repositioning, the clinician can also advise on handling and protective measures for that resident.

What to report and when to call 911

Whoever changes or checks the dressing sees the wound most often. Pass these observations to the treating clinician without waiting for the next visit:

• A dressing that sticks, or skin that lifts when it is removed
• New tears, blisters or a rash where tape or dressing edges sat
• A wound that measures larger or looks deeper than before
• Drainage that has increased or changed color
• A person who has started guarding the limb or refusing care

Call 911 for heavy bleeding, fainting or loss of consciousness, or sudden severe pain with a limb that cannot be moved.

Why primary care matters here

Several common medicines change how skin injures and heals. Blood thinners make bleeding and bruising heavier. Long-term steroid medicines can thin the skin. Medicines that cause drowsiness or lower blood pressure make a fall more likely. None of this means a medicine should be stopped. These drugs are prescribed for serious reasons, and only the prescriber should adjust them. What primary care can offer is a full medication review with the wound in mind, along with a check of vaccination records. Gateway shares the wound clinician’s notes with the primary care clinician, so that review starts from what was seen at the bedside.

Primary care at home in South St. Louis →

Getting care arranged in South St. Louis

For a resident of a nursing home, assisted living or memory care community in South St. Louis, a request for skin tear and traumatic wound care can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

South St. Louis patients are discharged from several hospitals, most often SSM Health Saint Louis University Hospital, Barnes-Jewish Hospital, SSM Health St. Mary’s Hospital in Richmond Heights and Mercy Hospital South. Gateway is an independent company and is not affiliated with any of them. Hospital social workers and case managers can refer a patient going home to the south side by phone or fax. Family members can call as well. We ask for the discharge summary and current wound orders, find out who helps the patient at home, and confirm a partner clinician’s availability for that neighborhood.

• 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 skin tears and traumatic wounds, or see everything Gateway arranges on the mobile wound care in South St. Louis 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
• Wounds with lymphedema
• Skin graft aftercare
• Wound VAC (NPWT) follow-up
• Skin tear and traumatic wound care in the City of St. Louis
• Skin tear and traumatic wound care in Downtown St. Louis
• Skin tear and traumatic wound care in Affton
• Skin tear and traumatic wound care in the Central West End

Common questions