What to know about skin tears and traumatic wounds

Young skin is anchored. Its outer and inner layers lock together with small ridges, a little like two egg cartons stacked. Over the decades those ridges flatten, the skin makes less collagen and natural oil, the cushion of fat beneath thins out, and small blood vessels grow brittle. The result is skin that slides, splits and bruises under forces a younger person would never notice. Most of those forces come from ordinary life: a hand gripping an arm during a transfer, a bed rail, a walker frame, a watch band, a pet’s claws, a fingernail, or a strip of tape peeled away. Dryness and years of sun make matters worse, which is one reason tears cluster on the forearms and the backs of the hands.

How the care plan is built

Assessment starts with the story of the injury. The treating clinician asks what the skin struck or what pulled on it, how long ago, how much it bled and what was done first. A fall changes the conversation, because other injuries have to be ruled out. The clinician also asks about diabetes and circulation problems, and about the date of the last tetanus vaccine, particularly when soil, rust or a dirty surface was involved. Those answers shape the plan as much as the wound’s appearance does. A clean tear in a well-nourished person and a contaminated scrape in someone with several health conditions call for different levels of watchfulness.

Arranging this care in St. Louis County

People in St. Louis County often move between settings without leaving the area: home, a hospital stay after a fall, a spell of rehabilitation, then home again or into assisted living down the road. An injury wound travels with them, and dressing plans tend to get lost at each handoff. Because Gateway arranges care in private homes and in the senior living communities and skilled nursing facilities close by, the same wound orders, records and supply list can follow the person. The treating clinician picks up from the last note instead of starting over.

St. Louis County wraps around the City of St. Louis on three sides, reaching from the Missouri River in North County to the Meramec River in the south and west past Chesterfield toward Franklin County. It is made up of dozens of municipalities plus large unincorporated areas, linked by Interstates 270, 64, 44, 55, 70 and 170. Distances add up here. For someone with a wound, a walker or a wheelchair, a drive across the county to an appointment can take most of a day, which is why care at home or in a facility matters.

Care at home

Some people with a traumatic wound already have a home health agency coming in, or qualify for one after a hospital stay. In that case the treating clinician’s orders go to the agency nurses who do the dressing changes, and Gateway keeps the two sides in step: shared notes, updated orders, and one plan instead of two. Supplies are handled the same way. The clinician orders the dressings and wraps the wound needs, and we coordinate getting them to the house so nobody is improvising from the medicine cabinet. Whether home health or particular supplies are covered depends on the plan and the provider.

For residents of nursing and senior living communities

Assisted living raises a practical question that nursing facilities do not: who is allowed to change the dressing? Staffing and licensing differ from one community to the next, and many rely on a visiting nurse, a home health agency or the family for wound care tasks. Gateway sorts this out at the start. We ask the community what its staff can do, share the treating clinician’s orders with whoever will carry them out, and arrange for supplies to be on hand in the resident’s apartment. The wellness nurse or director receives an update after each visit, and the family is told about changes to the plan.

What to report and when to call 911

Infection is the complication clinicians watch for most closely after a skin injury. Report these to the treating clinician or the facility nurse promptly:

  • Redness that is spreading outward from the wound
  • Skin around it that feels hot, hard or newly swollen
  • Thick, cloudy or foul-smelling drainage
  • Pain that is rising instead of easing
  • Fever, chills or feeling generally unwell

Call 911 if the person becomes confused, very drowsy, short of breath or faint, with or without a fever. Those can be signs that an infection is affecting the whole body and cannot wait for a scheduled visit.

Why primary care matters here

Several common medicines change how skin injures and heals. Blood thinners make bleeding and bruising heavier. Long-term steroid medicines can thin the skin. Medicines that cause drowsiness or lower blood pressure make a fall more likely. None of this means a medicine should be stopped. These drugs are prescribed for serious reasons, and only the prescriber should adjust them. What primary care can offer is a full medication review with the wound in mind, along with a check of vaccination records. Gateway shares the wound clinician’s notes with the primary care clinician, so that review starts from what was seen at the bedside.

Primary care at home in St. Louis County →

Getting care arranged in St. Louis County

Setting up skin tear and traumatic wound care for someone in St. Louis County usually goes in this order:

  1. You call 314-325-0126 or send the request care form, which asks only for a name and phone number.
  2. Gateway talks with you about the wound, the address and the insurance.
  3. We confirm availability for that location and gather records for the treating clinician.
  4. The clinician visits, assesses the wound and writes the orders.
  5. 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 skin tears and traumatic wounds, or see everything Gateway arranges on the mobile wound care in St. Louis County page.

Common questions

Is Gateway the right call for a fresh injury in St. Louis County, or should we go to the emergency room?

Gateway is not an emergency service. A wound that is deep, gaping, bleeding heavily, caused by a bite or holding a foreign object needs urgent or emergency care first, and 911 if the situation is serious. We arrange what comes after: follow-up visits for a wound that has already been seen, or assessment of a skin tear or scrape that is not an emergency but is not healing well.

Will insurance pay for traumatic wound care at home in St. Louis County?

It depends on the plan, the treating provider and the care that is needed, so we cannot tell you in advance that a service is a covered benefit. You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. Keep the insurance card handy when we talk, and we will help you work out which questions to put to the plan and the provider before care begins.

What should I have ready when I call about an injury wound?

A name and phone number are enough to start, and the web form asks for nothing more. For the conversation that follows, it helps to know when and how the injury happened, where on the body it is, what care it has had so far and where the person lives. A medication list, insurance card and any discharge papers from urgent care or the hospital are useful too.

Does Gateway arrange care in unincorporated St. Louis County?

Yes. Gateway coordinates care across St. Louis County, in incorporated cities and in unincorporated neighborhoods alike. What matters is the street address and the care setting, not which local government serves the block. When you call 314-325-0126, give the full address and ZIP code, and we will confirm whether a visit with a partner clinician can be arranged there.

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.