About non-healing wounds

Several common beliefs about slow wounds do not hold up. One is that a wound should be left open to the air to dry out and scab. For most chronic wounds clinicians aim for a moist, protected surface instead, though the choice of dressing is theirs to make. Another is that no pain means no problem. People with nerve damage can have a serious wound and feel almost nothing.

A third mistake is treating a wound that will not heal as a normal part of getting older. Age slows repair, but age alone does not keep a wound open. And many families assume a stronger cream is the missing piece, when the real barrier is pressure, swelling or blood flow that no ointment can correct.

What an assessment covers

At the visit, the treating clinician documents the wound in detail so that later visits have a baseline for comparison. That typically includes:

  • Length, width and depth, plus any tunnels or pockets under the skin edge
  • The kind of tissue in the base and how much of it looks healthy
  • The amount, color and odor of drainage
  • The condition of the edges and the surrounding skin
  • Pulses, skin temperature, swelling and sensation nearby

These findings point toward the type of wound and what is slowing it. The clinician then writes orders for dressings and any supporting measures, and sets a schedule for rechecking.

Local context: University City

People in University City often move between home, a nearby rehabilitation unit and a senior living community as their health changes, and a chronic wound travels with them. Each move risks a different dressing, a lost measurement history and a new set of nurses starting from zero. Gateway keeps the wound’s history together across those settings and arranges for a treating clinician to follow it where the person is staying, when availability allows. If an adult child nearby helps with dressings, we include them in scheduling and updates when the patient agrees.

University City begins where the Delmar Loop meets the St. Louis city line and runs west toward Interstate 170. Delmar Boulevard and Olive Boulevard carry traffic through it, and Clayton, Olivette and Overland are next door. This inner-ring suburb is dense by St. Louis County standards, with houses set close together and some residents who do not drive. For an older adult in an upstairs flat, or a person recovering from surgery, the hard part of an appointment is often the stairs and the ride, not the visit itself. Care at home removes both.

At home between visits

Most of the work on a slow wound happens between visits. Dressings are changed on the schedule the clinician ordered, by the patient, a family member or a visiting nurse. Someone keeps an eye on the drainage and the skin around the wound. Leg elevation, pressure relief or wraps are kept up day after day.

Gateway helps keep that routine from breaking down. We ask whether the dressing is manageable, relay questions to the treating clinician and schedule the next visit. If something changes, such as a hospital stay or a new caregiver, tell us so the plan and the visit schedule can be revisited.

For residents of nursing and senior living communities

Assisted living communities are not set up like nursing homes. Staff may help with medications and bathing but are often limited in the wound care they can provide, so a resident with a stalled wound can fall between services. Dressing changes may depend on a visiting home health nurse, a family member or the resident.

Gateway helps sort out who is doing what. We arrange the partner clinician’s visit to the resident’s apartment, find out what the community’s staff can assist with, and coordinate with any home health agency involved. The resulting plan is written for the help that is really available.

What to report and when to call 911

If you care for someone who cannot describe how they feel, you are the early warning. Let the treating clinician know about:

  • Guarding, flinching or crying out when the area is touched
  • Less interest in eating or drinking
  • New restlessness, sleepiness or confusion
  • A swollen limb, especially on one side only
  • Stains on bedding or clothing from drainage or blood

Write down the date you first noticed the change and mention it when you call. Do not wait on an emergency. Call 911 for bleeding you cannot control, fainting, a seizure, severe shortness of breath or sudden weakness on one side of the body.

Primary care and overall health

Two questions come up with nearly every stalled wound: what is this person eating, and what are they taking? Repair needs protein, calories, fluids and certain vitamins, and many older adults with wounds eat far less than they need. Some medicines, including steroids and drugs that act on the immune system, can slow repair as well.

Neither issue should be handled alone. Do not stop or change a medicine by yourself. A primary care clinician can review the full list with the wound in mind, check weight and labs, and weigh the tradeoffs. Arranging primary care alongside wound care makes that review far more likely to happen.

Primary care at home in University City →

How to get started in University City

If you have been managing a wound mostly on your own and are looking for non-healing wound care 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

Related care in University City

Read the full guide to non-healing wounds, or see everything Gateway arranges on the mobile wound care in University City page.

Common questions

How do I start non-healing wound care in University City if I do not have a referral?

Call 314-325-0126 or use the request form, which asks only for a name and phone number. Please leave medical details out of the form. We call back, ask about the wound, your location and the care setting, and confirm whether a partner clinician is available. With your permission we then request earlier records so the first visit is well informed.

Could a wound that will not heal be skin cancer?

Occasionally, yes. Some skin cancers look like a sore that never closes, and a wound that has been open for a very long time can, rarely, change. It is not the usual explanation, but it is one reason clinicians take a second look at wounds that do not respond to care. The treating clinician may take a small tissue sample to check. Ask about it if you are worried.

Will the clinician need to remove tissue from the wound, and does it hurt?

Removing dead or unhealthy tissue, called debridement, is common in chronic wound care because that tissue blocks repair and shelters bacteria. Whether it is needed, and by which method, is the treating clinician’s decision. Some methods are gentle and gradual. Others are done with instruments, with attention to comfort. Tell the clinician about your pain beforehand and ask what to expect.

Can a clinician visit a walk-up apartment in University City?

Yes. Visits are arranged in houses, flats and apartments, including upper floors without an elevator. When you call, tell us the unit number, how the entry works and where a visitor can park near the building. Those details go to the partner clinician ahead of the visit so time is not lost at the door.

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.