Wound care with lymphedema in University City.

Understanding 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 an assessment covers

Compression is the main tool for reducing lymphedema, but it is not right for every limb on every day. Before ordering it, the treating clinician checks blood flow to the foot or hand, sometimes with a simple circulation test, because squeezing a limb with poor arterial supply can do harm. Heart and kidney conditions are reviewed, since moving fluid out of the legs places extra load on the heart. Loss of feeling in the feet also matters. A person who cannot feel a wrap digging in cannot report it.

With that information the clinician decides whether to use compression, what kind, and how firm. The decision is revisited as the limb changes.

Arranging this care in University City

Across University City, the person helping with lymphedema care is often a spouse of about the same age. Lifting a heavy leg and applying layered wraps may be more than that person can safely do, and the treating clinician takes this into account when writing orders. With senior living communities and skilled nursing facilities close by, people also move between home and rehabilitation. Gateway works to carry the compression and dressing orders across each move, so the routine does not have to be rebuilt each time.

Homes in University City are mostly older: brick houses with front steps and second-floor bedrooms, two-family flats, and apartment and condominium buildings, some with elevators and some without. Senior apartments, assisted living and skilled nursing care are found within the city or a short drive away. Gateway arranges visits with partner clinicians in all of these places. When you call, mention details such as a buzzer entry, a walk-up floor or street-only parking, so the clinician knows what to expect on arrival.

Care at home

A home visit lets the treating clinician see the limb in the place where the swelling actually builds. The chair you spend the day in, the height of your bed and whether you have any way to prop up your legs all affect how much fluid collects. Those details are hard to describe in an office and easy to see in a living room.

It also spares you the trip. Moving a heavy, wrapped, draining leg into a car and through a waiting room is exhausting, and some people put off care because of it. Gateway arranges visits with partner clinicians in private homes, with availability confirmed by location.

Care in skilled nursing and assisted living

A resident with lymphedema usually has other conditions that the attending physician is managing, and several of them influence swelling. The treating wound clinician and the attending physician need the same information: what the wound looks like, what compression is in place, and whether fluid, weight or medicines have changed.

Gateway handles the paperwork side of that exchange. Visit findings and recommended orders go to the attending physician and the director of nursing, and relevant labs or notes from the facility come back to the wound clinician. Each clinician keeps authority over their own decisions, and the facility keeps one clear record.

Changes to report

Compression should feel snug and supportive. It should not hurt. Report these problems to the treating clinician, and ask ahead of time what to do if one of them shows up at night or on a weekend:

• Numbness, tingling or a pins-and-needles feeling below the wrap
• Toes or fingers that look pale, blue or dusky, or feel cold
• Pain that builds under the wrap instead of easing
• A wrap that has slid down, bunched up or formed a tight band
• Fluid soaking through the outer layer

Call 911 for chest pain, sudden shortness of breath, or a foot or hand that turns cold, white and severely painful.

How primary care fits in

Lymph flow in the legs gets much of its push from the calf and foot muscles squeezing with each step, so anything that limits walking tends to worsen swelling. Primary care can look at what is holding a person back, whether that is joint pain, breathlessness, weakness or fear of falling, and whether therapy would help.

General health affects the wound as well. Healing draws on protein and calories, high blood sugar slows repair and raises infection risk, and extra body weight adds pressure on lymph vessels in the groin and legs. These are long-term concerns that a primary care clinician follows alongside the wound visits.

Primary care at home in University City →

Arranging wound care with lymphedema in University City

If you have been managing a wound mostly on your own and are looking for wound care with lymphedema in University City, you can call Gateway yourself at 314-325-0126. Tell us what the wound looks like now, what the last clinician said about it and what is getting harder to manage. It helps to know the patient’s insurance and the names of the doctors involved, but do not wait until you have everything. We check whether a partner clinician can see the patient at home or in their facility, and we tell you what we find. The treating clinician takes it from there, and you stay part of the conversation.

Barnes-Jewish Hospital, a few miles east in the City of St. Louis, is where many University City residents have surgery or are admitted. Others use SSM Health St. Mary’s Hospital in Richmond Heights or Mercy Hospital St. Louis in Creve Coeur. Gateway has no affiliation with these hospitals. Our part comes after the discharge: a family member or a hospital case manager contacts us, we gather the records and the discharge orders, and we arrange follow-up with a partner clinician at the patient’s home or facility.

• County: St. Louis County, Missouri
• ZIP codes: 63130
• Nearby hospitals: Barnes-Jewish Hospital; SSM Health St. Mary's Hospital in Richmond Heights; Mercy Hospital St. Louis in Creve Coeur (not affiliated with Gateway)
• Nearby communities: Clayton and Central County, Overland, Central West End, Ladue, Creve Coeur
• 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 University City 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 Clayton and Central County
• Wound care with lymphedema in the Central West End
• Wound care with lymphedema in Ladue
• Wound care with lymphedema in Creve Coeur

Common questions