Understanding arterial and mixed wounds

An arterial ulcer is an open sore that develops because the arteries feeding the leg or foot have narrowed and can no longer carry enough blood to keep skin alive and repair it. Clinicians also call these ischemic wounds. They show up most on the tips of the toes, between the toes, on the heel, over the ankle bone and along the shin, places far from the heart or pressed on by shoes. The sore is often small, deep and dry, with a clean border. A mixed wound, sometimes called a mixed arterial-venous ulcer, sits on a leg where the veins are also failing, so swelling and drainage appear alongside the signs of a poor arterial supply.

What the treating clinician looks at

Bedside findings are often backed up by circulation tests. Depending on the situation, the treating clinician may order or request results from:

  • An ankle-brachial index, which compares blood pressure at the ankle and the arm
  • Toe pressures, often used when ankle arteries are too stiff to give a reliable reading
  • An arterial ultrasound that maps where flow narrows
  • A skin oxygen measurement near the wound

The numbers answer practical questions: whether the wound has a reasonable chance of closing with local care, whether a vascular specialist should be involved soon, and how much compression, if any, a swollen leg can tolerate.

Arterial and mixed wound care in Webster Groves

Many homes in Webster Groves were built with the bedrooms upstairs, and people with arterial pain often end up sleeping in a recliner on the main floor with their feet down. That eases the ache but can bring swelling and leave a heel pressed against a footrest for hours. A treating clinician who visits the home can see the setup and adjust the plan for heel protection and positioning. Gateway arranges those visits for long-time residents who want to stay in the houses they know, and coordinates supplies so protective padding and dressings are delivered there.

Large frame and brick houses are common in Webster Groves, often with the bedrooms and the only full bathroom upstairs. There are also smaller bungalows, apartments and condominiums near the business districts, and senior living that includes independent apartments, assisted living and skilled nursing care in and around the city. Gateway arranges visits with partner clinicians in each of these settings. In a private home, the clinician can see where the patient actually sleeps, sits and bathes, which often matters for a wound. In a facility, we coordinate timing and orders with the staff.

When care happens at home

When a home health agency is already visiting, its nurses and the wound care clinician need to work from the same orders. Gateway shares the treating clinician’s plan with the agency, so dressing changes between wound visits follow it and nobody applies a compression wrap that was not ordered.

Supplies are handled the same way. Once the clinician writes orders for dressings, padding or protective footwear, we coordinate the supply request and follow up on delivery to the home. If dressings are left over from an earlier leg wound, show them to the clinician before using them, because an arterial wound may call for something different.

Care in skilled nursing and assisted living

In a skilled nursing facility, partner clinicians see residents with arterial or mixed wounds on site and write recommendations for the attending physician and nursing staff. Facility nurses carry out the daily dressing orders and are well placed to catch change early, since they see the foot every shift.

Gateway coordinates the visit schedule with the director of nursing or wound nurse, sends visit notes for the chart, and tracks open items such as a pending circulation test. Clear documentation of whether compression is ordered for each leg matters here, because staff rotate and a routine wrap on the wrong leg is an avoidable error.

Changes to report

Arterial wounds can change quietly, so small differences are worth a call. Contact the treating clinician’s team promptly if you notice:

  • Pain that is stronger, or that now wakes you at night
  • A toe or patch of skin turning dusky, purple or black
  • The wound getting wider or deeper
  • New drainage or odor, or a dry scab turning soft
  • Redness or warmth spreading out from the wound

Call 911 if a foot or leg suddenly turns cold, pale or blue, goes numb, or becomes severely painful or hard to move. A sudden loss of blood flow is an emergency.

How primary care fits in

Two everyday factors have an outsized effect on arterial wounds: tobacco and movement. Nicotine in any form narrows blood vessels, so clinicians ask about it at nearly every visit, and a primary care clinician can talk through ways to quit when you are ready.

Walking is often encouraged for people with artery disease, yet an open foot wound may change what kind of activity is wise. Primary care and the wound clinician can agree on guidance that fits both. Gateway arranges the two services together so you hear one consistent message about activity, footwear and the goals for the leg.

Primary care at home in Webster Groves →

Getting care arranged in Webster Groves

You may already have a surgeon, a wound clinic or a home health nurse and still want help with arterial and mixed wound care closer to home in Webster Groves. That is a fine reason to call 314-325-0126. Tell us who is treating the wound now and what is not working, whether that is the travel, the gaps between appointments or unclear instructions. Gateway does not replace your current clinicians. We can arrange for a partner clinician to see the wound where you live and, with your permission, share notes with the offices already involved so the plans agree.

Families arranging care in Webster Groves should have the address, a phone number, the patient’s regular doctor and a list of current medications on hand when they call 314-325-0126. Mention which entrance has the fewest steps. We coordinate care in nearby Kirkwood, Shrewsbury, Maplewood, Brentwood, Crestwood and Affton as well, so a move to a relative’s home or a facility close by need not mean starting over. Availability is confirmed by location and care setting.

  • County: St. Louis County, Missouri
  • ZIP codes: 63119
  • Nearby hospitals: SSM Health St. Mary's Hospital in Richmond Heights; St. Luke's Des Peres Hospital; Mercy Hospital South (not affiliated with Gateway)
  • Nearby communities: Kirkwood, Shrewsbury, Maplewood, Brentwood, Crestwood, Affton
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

Read the full guide to arterial and mixed wounds, or see everything Gateway arranges on the mobile wound care in Webster Groves page.

Common questions

Can a wound care clinician come to a home in Webster Groves to look at an arterial ulcer?

Gateway arranges home visits from partner clinicians for arterial and mixed wounds, and availability is confirmed by location and care setting. Call 314-325-0126 or send a callback request with your name and phone number. We will ask where in Webster Groves the patient lives, what kind of home or facility it is, and whether any vascular records exist, then explain what happens next.

How can one wound be both arterial and venous?

The legs have two sets of vessels. Arteries carry blood down to the foot and veins carry it back up. Many older adults have disease in both. When weak veins cause swelling and skin breakdown on a leg where the arteries are also narrowed, the result is a mixed wound. It often looks like a venous ulcer, which is why clinicians check arterial flow before treating it as one.

Can an arterial ulcer heal without a procedure to open the artery?

Some do and some do not. It depends mainly on how much blood is reaching the area, along with infection, diabetes control and overall health. The treating clinician and, when involved, a vascular specialist weigh whether local wound care is likely to be enough or whether improving blood flow should come first. Not everyone is a candidate for a procedure, and in that case the plan centers on protection and comfort.

Can Gateway keep my regular Webster Groves doctor informed?

Yes. Tell us who your primary care doctor and specialists are when you call. Gateway shares visit records and the treating clinician’s orders with the rest of your care team, and passes questions back when they come up. Your regular doctor stays part of your care. The home visits add to that relationship and do not replace it.

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.