About venous leg ulcers
A venous leg ulcer is a break in the skin of the lower leg that stays open because the veins beneath it are not doing their job. Most appear between mid-calf and ankle, commonly on the inner side near the ankle bone. They are usually shallow, with an irregular outline and a moist red or yellowish base. Drainage can be heavy enough to soak through dressings and socks.
The skin nearby tells part of the story. It may look stained brown or purple, feel tight, hard or itchy, and swell more as the day goes on. Pain varies. Some people feel a dull ache that eases when the leg is raised, and others feel very little.
What the treating clinician looks at
The history shapes a venous ulcer plan as much as the exam does. The treating clinician asks how long the ulcer has been open, whether this leg has ulcerated before, and whether you have had a blood clot, a vein procedure, leg surgery or an injury. Allergies are reviewed, along with any skin reaction to past dressings, tapes or wraps, so the same products are not ordered again.
The clinician also asks what you have already tried and what happened. An ulcer that does not look or behave like a typical venous wound, or one that fails to respond, may lead to more tests or a referral to a vascular or skin specialist.
Local context: St. Louis City
City housing shapes venous ulcer care in the City of St. Louis. A third-floor walk-up means the leg hangs down and works hard on every trip, and a bulky multi-layer wrap may not fit the shoes you trust on stairs. Tell us about steps, elevators, entry buzzers and where a visiting clinician can park, so the visit is not delayed at the door. Dressing and compression supplies sent to an apartment building can sit in a lobby or mailroom, so we ask who can receive packages. The clinician can also suggest where in a small apartment you can raise your legs comfortably.
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
Most of the healing in a venous leg ulcer happens between visits. The treating clinician leaves instructions for those days: how long a wrap stays on, how to keep it dry, when to put your feet up, and what to do if a wrap slides down. If a wrap comes off early or drainage soaks through, call instead of waiting for the next scheduled visit. Gateway takes those calls, relays the question to the clinician and arranges whatever follows, such as a supply shipment or an earlier visit when one is available. Writing down questions as they come up makes each visit more useful.
For residents of nursing and senior living communities
A short rehabilitation stay after surgery or a hospital admission can be a turning point for a venous leg ulcer. Legs often swell more after days in bed and long hours in a wheelchair with the feet down. Therapy sessions, on the other hand, rebuild the walking and ankle movement that help veins work. Partner clinicians see patients on site and coordinate with nursing and therapy on details such as wrap changes around therapy times and footwear that fits over compression. Before discharge, Gateway helps line up continued visits and supplies at home so the plan does not lapse during the move.
What to report and when to call 911
Some changes point beyond the ulcer to the rest of the body. Tell the treating clinician promptly about:
- New swelling, pain or tenderness in one calf or thigh
- Swelling that rises quickly in both legs
- Rapid weight gain over a few days
- Needing more pillows to breathe comfortably at night
- A fall or a new injury to the leg
Call 911 right away for sudden shortness of breath, chest pain, coughing up blood, or a racing heartbeat with lightheadedness. These can be signs of a blood clot in the lungs or a heart problem, and they should not wait for a scheduled visit.
Primary care and overall health
Venous disease is a long-term condition, and the ulcer is one episode in it. Once the skin closes, someone needs to keep watching the legs, renew orders for compression garments as they wear out, and decide whether a referral to a vein specialist makes sense. That ongoing role usually belongs to primary care. A primary care clinician also weighs how other treatments affect the leg, such as blood thinners after a clot or a change in blood pressure medicine. For patients without a regular clinician, or who can no longer get to an office, Gateway can arrange primary care visits alongside wound care so follow-up continues.
Getting care arranged in the City of St. Louis
Clinicians and facility staff referring a patient for venous leg ulcer care in the City of St. Louis can call 314-325-0126 or fax 314-786-7966. Helpful to include: demographics and insurance, the working diagnosis, recent wound notes and measurements, current orders, the medication list and relevant test results. Please also tell us who should receive the treating clinician’s notes afterward. The online referral form takes contact details only, so clinical records should come by fax, not through the form. Gateway confirms that the referral arrived, checks availability for the patient’s address and lets your office know what has been scheduled.
Barnes-Jewish Hospital, beside Forest Park, and SSM Health Saint Louis University Hospital, on Grand Boulevard, are the two major hospitals in the City of St. Louis. Gateway is not affiliated with either. Both discharge patients to every part of the city, and some go home with wounds that need regular attention. Case managers and social workers can refer by phone at 314-325-0126 or by fax at 314-786-7966. Families can call directly. Once we have the discharge summary and orders, we look for a partner clinician for the patient’s neighborhood and report back.
- 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
More wound care in the City of St. Louis
Read the full guide to venous leg ulcers, or see everything Gateway arranges on the mobile wound care in the City of St. Louis page.
- Diabetic foot ulcers
- Pressure injuries and bed sores
- Arterial and mixed wounds
- 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
- Venous leg ulcer care in Downtown St. Louis
- Venous leg ulcer care in the Central West End
- Venous leg ulcer care in North St. Louis
- Venous leg ulcer care in South St. Louis
Common questions
My mother lives in a nursing home in the City of St. Louis. Can Gateway arrange venous ulcer care there?
Often, yes. Partner clinicians see residents in skilled nursing, assisted living, memory care and rehabilitation settings, working alongside the facility’s nurses and the attending physician. Start by telling us the facility’s name, or ask its nursing staff to contact Gateway. We confirm whether visits are available at that location and what the facility needs in order to begin.
Is it normal for a venous leg ulcer to hurt?
Many do, though the amount of pain varies widely. Aching and heaviness that ease with elevation are common. Pain at dressing changes can sometimes be reduced with a different dressing or approach, so mention it. Pain that suddenly gets worse, or pain with spreading redness, fever or cold, discolored toes, should be reported to the treating clinician promptly and not waited out.
Who arranges long-term compression garments for patients in the City of St. Louis once an ulcer has closed?
The treating clinician or your primary care clinician decides whether you need ongoing compression and at what strength. Garments usually require measuring, and they wear out and need replacing. Gateway can coordinate the order, the fitting and reminders for replacement, and can arrange primary care follow-up if you do not have a regular clinician. Payment for garments depends on your plan.
I live in a high-rise apartment building in the City of St. Louis. How do home visits work there?
Much the same as in a house. Give us the building address, your unit number, how visitors check in and where they can park or be dropped off. If the front desk needs advance notice of a visitor, tell us. The partner clinician comes to your apartment, and afterward Gateway coordinates any supplies, orders or follow-up visits the treating clinician decides on.
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.