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.

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.

Arranging this care in the City of St. Louis

In the City of St. Louis, the building itself is part of the care plan. A third-floor walk-up is hard on anyone whose calves cramp after a short distance, and each trip down the stairs for an appointment risks a bumped toe or shin. Care brought to the apartment avoids that. When Gateway schedules a visit, we ask about entry codes, buzzers, elevators and where a visiting clinician can park, so the time goes to the wound. For vascular testing at a nearby medical center, we help arrange transportation suited to someone who cannot walk far.

Almost every kind of housing is found in the City of St. Louis: single-family brick homes, two-family and four-family flats, downtown lofts, high-rise apartments, senior housing towers and large older homes divided into units. It also has many skilled nursing facilities, assisted living residences and rehabilitation centers. Gateway arranges partner clinician visits in all of these. For a high-rise, we ask about the front desk and where to park. For a flat, we ask which bell to ring. We collect those details so the treating clinician can focus on the patient.

Care at home

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.

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.

What to report and when to call 911

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

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 the City of St. Louis →

How to get started in the City of St. Louis

To arrange arterial and mixed wound care in the City of St. Louis, call Gateway at 314-325-0126. Patients, family members and caregivers can call directly, and a referral is not required. We will ask where the patient lives, what has been done for the wound so far and which clinicians are involved. Gateway then confirms whether a partner clinician is available for that address and care setting, requests the relevant records and schedules the visit. At that visit the treating clinician examines the wound and decides on the plan. Our job from then on is the coordination: orders, supplies, follow-up visits and keeping the care team informed.

An address that says St. Louis can be in the city or the county, so give the ZIP code and neighborhood when you call. Have a reliable phone number, the name of the patient’s doctor or health center, and any discharge papers. Gateway arranges care throughout the City of St. Louis, including Downtown, the Central West End, North St. Louis and South St. Louis, and in Clayton and Central County next door. Building access and parking affect visits here more than distance does, so tell us about entry doors, buzzers and elevators.

  • County: City of St. Louis, Missouri (an independent city)
  • ZIP codes: 63101, 63103, 63104, 63106, 63108, 63109, 63110, 63111, 63112, 63113, 63115, 63116, 63118, 63139, 63147
  • Nearby hospitals: Barnes-Jewish Hospital; SSM Health Saint Louis University Hospital (not affiliated with Gateway)
  • Nearby communities: Downtown St. Louis, Central West End, North St. Louis, South St. Louis, Clayton and Central County
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Related care in the City of St. Louis

Read the full guide to arterial and mixed wounds, or see everything Gateway arranges on the mobile wound care in the City of St. Louis page.

Common questions

If I see a vascular specialist near the City of St. Louis, 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 the City of St. Louis.

Will Medicare or my insurance cover arterial wound care and circulation testing?

You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Whether a visit, test or supply is a covered benefit depends on the treating provider, your specific plan and the care the clinician orders, so we cannot tell you in advance that something is a covered benefit. Have your insurance card handy when you call. We will explain what the treating provider’s office needs and what to ask your plan.

Why should I be careful with a heating pad or warm soak when my feet feel cold?

Feet with poor circulation often have reduced feeling as well, and skin that cannot sense heat or carry it away can burn at temperatures that seem mild. A burn on a poorly supplied foot becomes another wound to manage. Clinicians commonly suggest loose warm socks and blankets instead, and advise against soaking a foot with an open wound unless they have ordered it. Ask the treating clinician before using direct heat.

Is care in the City of St. Louis arranged differently than in St. Louis County?

The process is the same. The city and county are separate governments, but Gateway arranges care by address and care setting on both sides of the line. What differs is practical: parking, building entry, stairs and whether the patient has a phone that is answered. Sharing those details at the start helps the partner clinician plan a visit in the City of St. Louis.

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.