What to know about arterial and mixed wounds
Leg arteries narrow slowly as fatty deposits build up inside their walls, a condition called peripheral artery disease. For years the body copes by widening smaller side vessels. Then demand rises: a blister from a new shoe, a nick while trimming a nail, a scrape against a wheelchair footrest. Repairing an injury takes far more oxygen than keeping intact skin alive, and the narrowed arteries cannot supply the difference. The injury stalls and becomes an ulcer.
In a mixed wound, weak vein valves add a second problem. Fluid pools in the lower leg, the tissue swells and the skin breaks down more easily, while the limited arterial flow slows every stage of repair.
What the treating clinician looks at
Mixed wounds ask the treating clinician to balance two problems that pull in opposite directions. Vein disease calls for controlling swelling, usually with compression. Artery disease limits how much squeeze the leg can safely take. The clinician weighs the circulation results, the amount of swelling and drainage, and how the leg feels to the patient, then decides whether compression is appropriate and in what form.
The plan also covers care for the fragile, often discolored skin of the lower leg and dressings that can handle drainage. Orders are revisited as the leg changes, particularly after any vascular procedure.
Arterial and mixed wound care in St. Charles County
In St. Charles County, the adult son or daughter helping with an arterial wound often leaves for work early and gets home late. That leaves long daytime hours when nobody is looking at the foot. The treating clinician can set up a routine that fits a commuter’s schedule, such as a foot check before work and again in the evening, with written notes on what to report. Gateway schedules visits around the caregiver’s availability when possible and passes along updates by phone. For a parent moving into one of the newer senior living communities nearby, we coordinate with staff there too.
Because the county is so varied, its care settings are too: older houses in the river towns, large suburban subdivisions, apartments and villas, farmhouses toward the edges, and a growing number of senior living, assisted living, memory care and skilled nursing communities. Gateway arranges partner clinician visits across this range. A request for a rural home may take more planning than one for a facility near the interstate. In every case we confirm the setting, find out who is involved in daily care and share the treating clinician’s orders with them.
Care at home
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
Residents in memory care may not be able to say that a foot hurts or remember bumping a shin. With arterial disease, that makes staff observation the main early warning. Pain may show up as restlessness at night, guarding a foot, refusing shoes or pulling at a dressing.
The treating clinician takes these reports seriously and builds a plan the unit can carry out, with dressings that stay in place and footwear that protects without rubbing. Gateway coordinates visits around the resident’s routine, keeps the attending physician informed and gives the family one contact for updates.
Signs to tell the clinician about
Arterial wounds can change quietly, so small differences are worth a call. Contact the treating clinician’s team promptly if you notice:
- Pain that is stronger, or that now wakes you at night
- A toe or patch of skin turning dusky, purple or black
- The wound getting wider or deeper
- New drainage or odor, or a dry scab turning soft
- Redness or warmth spreading out from the wound
Call 911 if a foot or leg suddenly turns cold, pale or blue, goes numb, or becomes severely painful or hard to move. A sudden loss of blood flow is an emergency.
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.
How to get started in St. Charles County
If you have been managing a wound mostly on your own and are looking for arterial and mixed wound care in St. Charles County, 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.
Start with the town and ZIP code, since St. Charles County includes everything from 63301 in St. Charles to 63385 in Wentzville. If the home is outside city limits, describe the nearest highway or crossroads. Keep the patient’s phone number, doctors’ names and insurance cards nearby. Gateway arranges care in St. Charles, St. Peters, O’Fallon, Wentzville, Lake St. Louis and Cottleville. In the outlying parts of the county, visit days depend more on location, so calling early gives us more room to plan.
- County: St. Charles County, Missouri
- ZIP codes: 63301, 63303, 63304, 63376, 63366, 63368, 63385, 63367
- Nearby hospitals: SSM Health St. Joseph Hospital in St. Charles; SSM Health St. Joseph Hospital in Lake Saint Louis; Barnes-Jewish St. Peters Hospital; Progress West Hospital in O'Fallon (not affiliated with Gateway)
- Nearby communities: St. Charles, St. Peters, O'Fallon, Missouri, Wentzville, Lake St. Louis, Cottleville
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
Related care in St. Charles County
Read the full guide to arterial and mixed wounds, or see everything Gateway arranges on the mobile wound care in St. Charles County page.
- Diabetic foot ulcers
- Venous leg ulcers
- Pressure injuries and bed sores
- Non-healing wounds
- Post-surgical wounds
- Reopened (dehisced) surgical wounds
- Surgical site infections
- Skin tears and traumatic wounds
- Wounds with lymphedema
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Arterial and mixed wound care in St. Charles
- Arterial and mixed wound care in St. Peters
- Arterial and mixed wound care in O'Fallon
- Arterial and mixed wound care in Wentzville
Common questions
My father lives in a nursing facility in St. Charles County. 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 St. Charles County 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.
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.
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.
Our company runs facilities in more than one St. Charles County city. Can Gateway work with all of them?
Yes. Gateway arranges partner clinician visits in skilled nursing, assisted living, memory care and rehabilitation settings throughout St. Charles County. A regional nurse or administrator can make one call to discuss several locations. We agree on a referral process for each building, coordinate orders, supplies and documentation with staff, and confirm clinician availability location by location. Referrals can be faxed to 314-786-7966.
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.