What to know about venous leg ulcers

Leg veins have to push blood uphill. They rely on two helpers: one-way valves inside the vein, and the calf muscle, which squeezes the veins with every step. When valves wear out or are damaged by an old blood clot, blood slips backward and collects near the ankle. Pressure in those veins stays high whenever you sit or stand.

That pressure forces fluid and blood cells out into the tissue, which swells, stiffens and receives less oxygen and nourishment than healthy skin. Skin in that state is easy to injure and slow to mend. A scrape from a walker, an insect bite or scratching an itchy patch can be enough to start an ulcer.

How the care plan is built

A first visit for a venous leg ulcer covers more than the wound. The treating clinician typically records:

  • Where the ulcer sits, and its length, width and depth
  • The appearance of the wound base and edges
  • How much drainage there is and what it looks like
  • The surrounding skin: staining, hardening, rash, or pale soggy areas
  • Swelling in both legs, often measured at the ankle and calf
  • Pain, and what makes it better or worse

Those findings become the baseline. The same points are checked again at later visits, so the care plan is adjusted on what the leg is doing, not on guesswork.

Venous leg ulcer care in University City

Many people with venous leg ulcers in University City have lived in the same house for decades, and some later move to a senior living community or skilled nursing facility a short drive away. The ulcer plan should move with them. Gateway keeps track of the measurements, compression orders and supply details, so when someone goes from home to a rehabilitation stay and back, the receiving nurses know what was on the leg and why. Because partner clinicians see patients in both homes and facilities, the plan can often continue without starting the assessment over.

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.

When care happens at home

Most of the healing in a venous leg ulcer happens between visits. The treating clinician leaves instructions for those days: how long a wrap stays on, how to keep it dry, when to put your feet up, and what to do if a wrap slides down. If a wrap comes off early or drainage soaks through, call instead of waiting for the next scheduled visit. Gateway takes those calls, relays the question to the clinician and arranges whatever follows, such as a supply shipment or an earlier visit when one is available. Writing down questions as they come up makes each visit more useful.

Care in skilled nursing and assisted living

Assisted living is a different setting from a nursing home. Staff may help with bathing and dressing, but licensed nursing hours are often limited, and many communities do not apply compression wraps. For a resident with a venous leg ulcer, that affects the plan. The treating clinician may choose compression that stays on between visits, or a type that a home health nurse reapplies. Gateway coordinates with the community’s nurse or wellness director, the family and any home health agency so each knows who is responsible for which task. We also ask staff to report slipped wraps, wet dressings and new swelling early.

What to report and when to call 911

Some changes point beyond the ulcer to the rest of the body. Tell the treating clinician promptly about:

  • New swelling, pain or tenderness in one calf or thigh
  • Swelling that rises quickly in both legs
  • Rapid weight gain over a few days
  • Needing more pillows to breathe comfortably at night
  • A fall or a new injury to the leg

Call 911 right away for sudden shortness of breath, chest pain, coughing up blood, or a racing heartbeat with lightheadedness. These can be signs of a blood clot in the lungs or a heart problem, and they should not wait for a scheduled visit.

Why primary care matters here

A draining venous ulcer asks a lot of the body. Protein is lost in wound fluid, and healing skin needs steady calories, protein and fluids to rebuild. Older adults with a poor appetite, dental problems or a tight food budget can fall behind without anyone noticing. A primary care clinician can check weight trends and lab work, look for anemia, and review diabetes control, since high blood sugar slows repair and raises infection risk. Body weight matters as well, because extra weight adds pressure to leg veins. None of this replaces wound care. It supports it, which is why Gateway can arrange both.

Primary care at home in University City →

How to get started in University City

Setting up venous leg ulcer care for someone in University City 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.

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 venous leg ulcers, or see everything Gateway arranges on the mobile wound care in University City page.

Common questions

My mother lives in a nursing home in University City. Can Gateway arrange venous ulcer care there?

Often, yes. Partner clinicians see residents in skilled nursing, assisted living, memory care and rehabilitation settings, working alongside the facility’s nurses and the attending physician. Start by telling us the facility’s name, or ask its nursing staff to contact Gateway. We confirm whether visits are available at that location and what the facility needs in order to begin.

Is it normal for a venous leg ulcer to hurt?

Many do, though the amount of pain varies widely. Aching and heaviness that ease with elevation are common. Pain at dressing changes can sometimes be reduced with a different dressing or approach, so mention it. Pain that suddenly gets worse, or pain with spreading redness, fever or cold, discolored toes, should be reported to the treating clinician promptly and not waited out.

What should I have ready before the first visit?

A few things help: a list of your medications and allergies, the names of your other clinicians, any recent hospital or clinic records about the leg, and results of circulation tests if you have had them. Keep the dressings and wraps you are using now so the clinician can see them. If a family member helps with your care, ask them to be present or available by phone.

Is University City handled differently from the City of St. Louis?

No. University City is a separate city in St. Louis County, but for arranging care the border makes no difference. Gateway coordinates care on both sides of the city line, including the Central West End and Clayton. Give us the street address and ZIP code, such as 63130, and we confirm availability for that location and 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.