What to know about wounds with lymphedema
Wounds form on a limb with lymphedema because swollen tissue is fragile tissue. Fluid pushes skin cells farther from the small blood vessels that feed them, so oxygen and nutrients arrive slowly. The stretched surface tears easily, and a scratch from a pet, a bump against a bed frame or a rubbing shoe can open it.
Once the skin is open, lymph fluid seeps out. The steady moisture softens the surrounding skin until it turns white and breaks down, and the open area widens. Bacteria that would normally be carried away by lymph flow linger in the tissue. Each problem feeds the next, which is why treating clinicians usually address the swelling and the wound in the same plan.
What an assessment covers
A first assessment usually starts with the story of the swelling. The treating clinician asks when it began, whether it affects one limb or both, and whether it goes down overnight. A history of cancer treatment, leg surgery, injuries, blood clots or repeated skin infections matters, and so does the list of current medicines.
This history points to the cause, or more often the mix of causes, and that shapes the care plan. Swelling driven mostly by the lymphatic system is handled differently from swelling driven by the heart, the kidneys or the veins. The clinician may want records or test results from other offices, and Gateway gathers those ahead of the visit when it can.
Arranging this care in Washington
Daily life in Washington often includes yard work, gardens, pets and gravel driveways, and each brings small scratches, insect bites and stubbed toes. On a limb with lymphedema, minor skin breaks like these are a common starting point for wounds and infections, and help is farther away than it is in the city. Report them by phone early, even between visits. When Gateway arranges care here, we plan visit days, supply shipments and home health involvement in advance, and we confirm which partner clinicians serve your area first.
In Washington you will find older houses near the riverfront downtown, newer subdivisions on the edges of the city, apartments, and farmhouses and homes on acreage in the countryside beyond. Senior apartments, assisted living and skilled nursing facilities serve the city and the smaller towns around it. Gateway arranges visits with partner clinicians in these settings. Because Washington is farther out than most communities we coordinate, we confirm availability by address before anything is scheduled. Clear directions matter on rural routes, so we ask for them.
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
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.
Changes to report
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.
Getting care arranged in Washington
Before anything is scheduled, Gateway checks two things for every request for wound care with lymphedema in Washington: whether a partner clinician serves that address and care setting, and what the patient’s plan requires from the treating provider. Neither is assumed. If both line up, we arrange the visit and gather records. If something stands in the way, we say so, and our guide to following up on a request explains what to ask next. Gateway coordinates the care and does not make clinical decisions. Those belong to the treating clinician who sees the wound. Start by calling 314-325-0126, or ask a family member to call for you.
Mercy Hospital Washington is the hospital most local families know, and it is where many people in Washington are admitted or have surgery before coming home. Gateway is not affiliated with the hospital. When a discharge is planned, a relative or a discharge planner can call or fax us with the basics. We request the records, coordinate the treating clinician’s orders and arrange follow-up at the home or facility. Patients sent to a St. Louis hospital for specialty care and then returned to Washington can be referred the same way.
- County: Franklin County, Missouri
- ZIP codes: 63090
- Nearby hospitals: Mercy Hospital Washington (not affiliated with Gateway)
- Nearby communities: Franklin County, Eureka, Wildwood
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
More wound care in Washington
Read the full guide to wounds with lymphedema, or see everything Gateway arranges on the mobile wound care in Washington 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 Franklin County
- Wound care with lymphedema in Wildwood
Common questions
Can a wound care clinician come to a home in Washington for a lymphedema wound?
Gateway arranges home visits with partner clinicians across Greater St. Louis and the Metro East, and availability in Washington is confirmed by address and care setting. Call 314-325-0126 to ask. It helps to have a list of your medicines, the names of the clinicians you see and any wraps or garments you have tried. The treating clinician decides what care is needed after seeing the limb.
Why do I keep getting cellulitis in the same leg?
A limb with lymphedema clears bacteria slowly, so germs that get in through a crack, a blister or peeling skin between the toes can take hold quickly. Each infection can scar more lymph vessels, which adds swelling and sets up the next one. Tell your clinicians how often it has happened. They can look for the entry points and decide what prevention makes sense for you.
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.
Do you arrange care for people on rural roads outside Washington?
Requests from outside the city limits are welcome. Give us the full address, the nearest highway or county road and any directions a first-time visitor would need, such as a gate, a long driveway or a house that sits back from the road. Gateway confirms availability for that location, then coordinates the visit with a partner clinician.
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.