About venous leg ulcers

A venous leg ulcer is a break in the skin of the lower leg that stays open because the veins beneath it are not doing their job. Most appear between mid-calf and ankle, commonly on the inner side near the ankle bone. They are usually shallow, with an irregular outline and a moist red or yellowish base. Drainage can be heavy enough to soak through dressings and socks.

The skin nearby tells part of the story. It may look stained brown or purple, feel tight, hard or itchy, and swell more as the day goes on. Pain varies. Some people feel a dull ache that eases when the leg is raised, and others feel very little.

What an assessment covers

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.

Local context: Washington, Missouri

For patients in Washington, running out of supplies is a bigger problem than it is closer to the city. The right absorbent dressing or wrap layer is rarely on a local pharmacy shelf, and a draining ulcer covered with a poor substitute can quickly damage the surrounding skin. Gateway plans supply orders ahead of need and asks whether an order can include a reserve for weeks when weather delays a delivery or a visit. We also make sure you know whom to call between visits, and which changes mean going to the nearest emergency department.

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

At a home visit, the partner clinician removes the old wrap and dressing, checks the skin, measures the ulcer and the swelling, and reapplies what was ordered. Seeing the home helps. The clinician can look at the chair where you spend most of the day, whether a footstool or recliner raises your legs, and how far you walk to the bathroom or kitchen. Details like these often explain why a leg is more swollen on some days than others. Gateway schedules the visits, confirms the day with you or a family member, and passes the clinician’s notes and orders to the others involved in your care.

Care in skilled nursing and assisted living

Residents in memory care may not understand why a leg is wrapped. They may pull at the bandage, scratch the skin beneath it or be unable to say that it feels too tight. The treating clinician takes that into account when choosing dressings and compression, and may adjust the plan when a resident does not tolerate a wrap. Staff observations carry extra weight here. Restlessness, guarding the leg, a change in walking or a new refusal to wear shoes can all signal discomfort. Gateway shares the clinician’s instructions with the care team and keeps the family or legal representative updated on visits and changes.

Changes to report

Changes in the skin around a venous ulcer are worth reporting even when the wound itself looks the same. Let the treating clinician know about:

  • Dressings that soak through earlier than expected
  • Skin near the ulcer that turns white, soggy or raw
  • A new itchy rash or blisters under a dressing, tape or wrap
  • A new open area anywhere on either leg
  • Clear fluid weeping from skin that was intact
  • A dressing or wrap that got wet or dirty

Call 911 if bleeding will not stop with firm pressure, or if the person becomes confused, very drowsy or hard to wake.

Why primary care matters here

Venous disease is a long-term condition, and the ulcer is one episode in it. Once the skin closes, someone needs to keep watching the legs, renew orders for compression garments as they wear out, and decide whether a referral to a vein specialist makes sense. That ongoing role usually belongs to primary care. A primary care clinician also weighs how other treatments affect the leg, such as blood thinners after a clot or a change in blood pressure medicine. For patients without a regular clinician, or who can no longer get to an office, Gateway can arrange primary care visits alongside wound care so follow-up continues.

Primary care at home in Washington →

Getting care arranged in Washington

For a resident of a nursing home, assisted living or memory care community in Washington, a request for venous leg ulcer care can come from the family, the resident or the facility’s nurses. Call 314-325-0126 and give us the facility name, the unit or room and the best nurse contact. Gateway speaks with the facility about its process for outside clinicians, confirms availability and coordinates a visit time that fits the resident’s day. After the visit, the treating clinician’s orders are given to facility nursing, and the family contact on file gets an update if the resident has agreed to that.

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

Common questions

My mother lives in a nursing home in Washington. 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.

Can I shower or bathe with a compression wrap on?

Most wraps need to stay dry, because a wet wrap can irritate skin and lose its hold. How you bathe depends on the type of compression ordered. Some garments come off for bathing, while layered wraps usually stay on until the next change. Ask the treating clinician what applies to you and which cover, if any, they suggest. Report a wrap that gets wet.

Will Medicare or my insurance pay for compression supplies and visits?

You can ask us about Medicare, Medicare Advantage, Medicaid and commercial plans. What is paid for depends on the treating provider, your specific plan and the care that is needed, and rules for compression garments and dressings vary a good deal from plan to plan. Gateway helps confirm the details before care starts so you can decide with clear information.

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.