What to know about arterial and mixed wounds
An arterial ulcer is an open sore that develops because the arteries feeding the leg or foot have narrowed and can no longer carry enough blood to keep skin alive and repair it. Clinicians also call these ischemic wounds. They show up most on the tips of the toes, between the toes, on the heel, over the ankle bone and along the shin, places far from the heart or pressed on by shoes. The sore is often small, deep and dry, with a clean border. A mixed wound, sometimes called a mixed arterial-venous ulcer, sits on a leg where the veins are also failing, so swelling and drainage appear alongside the signs of a poor arterial supply.
What an assessment covers
A care plan for an arterial wound usually runs on two tracks. One protects the wound: dressings matched to how dry or moist it is, padding and footwear that keep pressure and friction off the area, and a close watch for infection. The other addresses the blood supply, which may mean a referral to a vascular specialist to see whether a procedure could open or bypass the narrowed artery.
The treating clinician sets the order of these steps. Until circulation is understood, the plan tends to be cautious, with an emphasis on keeping stable tissue stable instead of pushing for fast changes at the wound.
Arranging this care in St. Louis County
People in St. Louis County often move between settings without going far: a hospital stay for a vascular procedure, a few weeks in a nearby skilled nursing or rehabilitation center, then home or to a senior living community close by. An arterial wound has to be followed through each move, and orders about compression, dressings and weight on the foot must travel with it. Gateway keeps the wound records and the treating clinician’s current orders together across those handoffs, so each new nursing team starts from the same plan and the family is not left carrying paperwork.
Housing in St. Louis County changes by area. The inner suburbs and Mid County have older brick homes, two-story houses and apartment buildings. North County and South County have many one-story ranch homes on quiet streets. West County has newer subdivisions, condominiums and villas. Every part of the county also has skilled nursing facilities, assisted living, memory care and rehabilitation centers. Gateway arranges visits from partner clinicians in each of these settings and handles the scheduling, records, orders and supplies around the visit, whether the address is a house, an apartment or a facility room.
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
Assisted living staff usually help with daily routines but may not perform wound care, so arterial wounds in these communities often involve a home health agency, the resident’s own physician and family. Gateway helps connect those pieces. The treating clinician visits the resident’s apartment, and we share the plan with the nurse or wellness director, the agency and the family contact.
Aides who help with bathing and dressing can be told what to watch for on the feet, such as a new dark spot on a toe or a sock that leaves a deep groove, and whom to tell when they see it.
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.
Primary care and overall health
Healing draws on the whole body. High blood sugar damages small vessels and weakens the response to infection. Kidney disease, anemia and a poor appetite each limit what reaches the wound. A primary care clinician can check labs, review how well diabetes is controlled, and look at whether you are eating enough protein and calories to rebuild tissue.
When wound care and primary care are arranged together, a wound that stalls prompts a wider look at health and not only a change of dressing. Findings from either visit reach the other clinician through Gateway’s coordination.
Arranging arterial and mixed wound care in St. Louis County
Clinicians and facility staff referring a patient for arterial and mixed wound care in St. Louis County 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.
Start with the municipality or ZIP code when you call 314-325-0126, because the same street name can appear in more than one St. Louis County town. Have the patient’s name, a phone number, the regular doctor’s name and any discharge papers within reach. Gateway also coordinates care in North County, South County, Chesterfield and West County, Clayton and Central County, Kirkwood and Florissant. Visit availability is confirmed by address and care setting, so the exact location helps us answer accurately.
- County: St. Louis County, Missouri
- Nearby hospitals: Mercy Hospital St. Louis in Creve Coeur; Missouri Baptist Medical Center in Town and Country; St. Luke's Hospital in Chesterfield; Mercy Hospital South; Christian Hospital in North County; SSM Health DePaul Hospital in Bridgeton; SSM Health St. Mary's Hospital in Richmond Heights; SSM Health St. Clare Hospital in Fenton (not affiliated with Gateway)
- Nearby communities: North County, South County, Chesterfield and West County, Clayton and Central County, Kirkwood, Florissant
- 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 St. Louis 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 North County
- Arterial and mixed wound care in South County
- Arterial and mixed wound care in Chesterfield and West County
- Arterial and mixed wound care in Clayton and Central County
Common questions
If I see a vascular specialist near St. Louis County, 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 St. Louis County.
Is walking good or bad when I have a foot wound from poor circulation?
Walking is commonly recommended for artery disease in general, but an open wound on the foot changes the picture. Pressure and rubbing can hold a wound back, and the right shoe or protective device matters. Ask the treating clinician how much to walk, what to wear on the foot and whether any part of it should be kept free of weight. The answer is individual.
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.
I live out of state. Can I set up care for a parent in St. Louis County?
You can. Family members can call Gateway directly, with or without a referral, from anywhere. Tell us your parent’s address in St. Louis County, the best phone number for them and for you, and who their doctor is. With your parent’s agreement, we coordinate the visit and keep you informed by phone, so you are not relying on secondhand updates.
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.