About wounds with lymphedema
Lymphedema is long-term swelling that builds when the lymphatic system cannot carry fluid out of an arm or leg as fast as it collects. The lymphatic system is a network of thin vessels and nodes that returns fluid to the bloodstream and helps the body fight infection. When it falls behind, fluid that is rich in protein settles in the tissue under the skin.
A lymphedema wound is any open area on a limb swollen this way. It may be a shallow raw patch, a blister that has burst, a split at the bottom of a skin fold or a deeper ulcer. Most are on the lower legs, ankles and feet. What they share is the setting: skin that is stretched, damp and slow to repair itself.
What the treating clinician looks at
The care plan for a lymphedema wound has to fit the person who will live with it. The treating clinician weighs practical questions alongside the clinical ones:
- Can you reach your own feet, and do you have the hand strength to manage wraps or garments?
- Who is available to help, and at what times of day?
- Where do you rest, and can the limb be raised there?
- What will you wear on your feet over the wraps?
The answers shape the orders. A plan built on a garment that nobody in the house can put on will not last. Gateway then coordinates the supplies, any home health involvement and the follow-up schedule the clinician sets.
Wound care with lymphedema in St. Louis County
Many people in St. Louis County have lived in the same house for decades and have managed swollen legs on their own for nearly as long, often with worn stockings and a routine that worked until the skin opened. Older homes add their own difficulties: a tub to step over when legs need washing, a bathroom up the stairs, a favorite chair with no way to raise the feet. A treating clinician visiting at home can see these and suggest workable changes. Gateway coordinates the visit and any garments or supplies ordered.
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
Few people with lymphedema in the legs can manage the care alone. Reaching the feet, lifting a heavy limb and applying layers of wrap take flexibility and strength that the condition itself wears away. A spouse, an adult child or a paid caregiver often does the daily skin care, and the treating clinician may order home health nursing for dressing changes and compression.
Gateway shares the clinician’s orders with the home health agency and coordinates the schedule so everyone follows one plan. Caregivers are welcome at visits. It is the right time to ask what you are expected to do and what should be left to a nurse.
Care in skilled nursing and assisted living
Memory care and assisted living bring their own challenges for lymphedema. A resident with dementia may pull at a wrap, unroll it or be unable to say that it hurts, so staff need to know what to watch for: toes changing color, a wrap bunched behind the knee, fluid soaking through. The treating clinician takes this into account when choosing the type of compression.
Assisted living staff are often not permitted to change dressings or apply wraps. In that case the clinician may order home health nursing to come to the apartment, and Gateway coordinates among the agency, the community and the family.
What to report and when to call 911
Skin infection is the complication to watch most closely with lymphedema, because it can spread through a swollen limb quickly. Contact the treating clinician promptly if you notice:
- Redness that is new or spreading, or red streaks running up the limb
- Skin that feels hot or newly tender
- Fever, chills or body aches
- Drainage that turns cloudy, thick or foul smelling
- Pain that is clearly worse than usual
Do not wait for the next scheduled visit to mention these. Call 911 if a person with these signs becomes confused, faint, very drowsy or short of breath.
How primary care fits in
Medicines are part of the swelling picture. Some commonly prescribed drugs, including certain blood pressure, diabetes, pain and hormone medicines, can cause the legs to hold fluid. Water pills reduce some kinds of swelling and do little for others, and they can affect the kidneys and blood pressure along the way.
Sorting this out is a job for the prescriber. Do not stop or change a medicine on your own because of swelling. A primary care visit that includes a full medication review gives the prescriber and the wound clinician a shared, current list, and Gateway coordinates the records so both are working from it.
Arranging wound care with lymphedema in St. Louis County
Setting up wound care with lymphedema for someone in St. Louis County usually goes in this order:
- You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
- Gateway talks with you about the wound, the address and the insurance.
- We confirm availability for that location and gather records for the treating clinician.
- The clinician visits, assesses the wound and writes the orders.
- We follow up on supplies, the next visit and communication with your other clinicians.
You do not need a confirmed diagnosis to start.
Where someone is hospitalized in St. Louis County usually depends on where they live. West County families often use Mercy Hospital St. Louis in Creve Coeur, Missouri Baptist Medical Center in Town and Country or St. Luke’s Hospital in Chesterfield. South County has Mercy Hospital South and SSM Health St. Clare Hospital in Fenton. North County has Christian Hospital and SSM Health DePaul Hospital in Bridgeton, and Mid County has SSM Health St. Mary’s Hospital in Richmond Heights. Gateway is not affiliated with these hospitals. After discharge, families and discharge planners can contact us to arrange follow-up.
- 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 wounds with lymphedema, 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
- Arterial and mixed wounds
- Non-healing wounds
- Post-surgical wounds
- Reopened (dehisced) surgical wounds
- Surgical site infections
- Skin tears and traumatic wounds
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Wound care with lymphedema in North County
- Wound care with lymphedema in South County
- Wound care with lymphedema in Chesterfield and West County
- Wound care with lymphedema in Clayton and Central County
Common questions
Will Medicare or my health plan pay for lymphedema wound care in St. Louis County?
It depends. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Whether a provider participates, and what your benefits are, depends on the treating provider, your plan and the care the clinician orders. Visits, dressings, compression garments and pumps are often handled under different rules. We go over these questions with you before care starts.
Can I shower with a lymphedema wound and compression wraps?
Ask the treating clinician, because the answer depends on the dressing and the type of compression. Some wraps are meant to stay on and stay dry for several days, while others come off daily. Clean skin matters a great deal with lymphedema, so the clinician will explain how washing fits into your routine and how to protect anything that must not get wet.
Why does the skin on my swollen leg look thick and bumpy?
When protein-rich lymph fluid sits in the tissue for months or years, the skin responds by thickening and hardening. It may form deep creases at the ankle or grow small wart-like bumps, especially on the feet and toes. These changes are a sign of long-standing lymphedema. They make skin harder to keep clean and more likely to crack, so point them out to the treating clinician.
My mail says St. Louis. Does it matter whether I live in the city or in St. Louis County?
Not for requesting care. Many St. Louis County homes have a St. Louis mailing address, and Gateway coordinates care in both the county and the City of St. Louis. Give us the street address and ZIP code and we will sort out the location. Visit availability is confirmed for that specific address and the care setting.
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.