Limb Preservation Wound Care in St. Louis

What limb preservation means

Limb preservation is an approach to foot and leg wounds that could lead to amputation if the problems behind them are not addressed. It is less a single treatment than a way of organizing care. The wound, the blood supply, pressure on the foot, infection and overall health are looked at together, by clinicians who share what they find.

Gateway arranges limb preservation wound care in St. Louis and the Metro East by connecting patients with partner clinicians and coordinating the specialist appointments, tests and supplies around those visits. Keeping the limb is the goal, not a promise.

Who is at higher risk

Most limb-threatening wounds start small. The risk rises when a wound sits on a foot or leg with one or more of these problems:

Diabetes with nerve damage, which can hide the pain of a blister, callus or cut and lead to diabetic foot ulcers
Reduced blood flow from peripheral artery disease, the usual cause of arterial and mixed wounds
A past foot ulcer, or a previous amputation of a toe or part of a foot
Kidney disease, especially for people on dialysis
A foot shape, walking pattern or shoe that keeps pressure on one spot

What the treating clinician may do for a high-risk wound

The partner clinician decides what the wound and the limb need. Depending on what is found, that may include:

Examining the wound, the surrounding skin, the pulses and the feeling in the feet
Ordering circulation testing, such as an ankle-brachial index or other vascular studies
Removing dead tissue when blood flow and the setting make that appropriate
Ordering a way to take pressure off the wound, known as offloading
Evaluating for infection, which can mean cultures, lab work or imaging
Referring to podiatry, vascular surgery, infectious disease or another specialty

How Gateway coordinates the team

A high-risk wound can involve several offices at once, and care tends to break down in the gaps between them. That is where Gateway works:

Gathering prior wound notes, vascular test results, imaging reports and medication lists before the visit
Scheduling wound visits at home or in a facility, where a partner clinician is available
Tracking referrals so that an ordered vascular or podiatry appointment gets made and kept, through our vascular and specialist referral coordination
Following up on orders for dressings, offloading devices and protective footwear
Sending visit findings to every clinician involved

Limb preservation at home and in facilities

Many people with limb-threatening wounds have trouble getting to appointments, and walking on the wound to get there can work against the plan. Partner clinicians see patients in private homes, skilled nursing facilities, assisted living, memory care and rehabilitation centers. Availability is confirmed by location and care setting.

Some care cannot come to the bedside. Vascular procedures, advanced imaging and surgery happen in hospitals and procedure centers. Gateway helps arrange transportation for those trips and gets the results back to the wound clinician.

Primary care and the conditions behind the wound

Blood sugar, blood pressure, kidney function, nutrition and smoking all affect whether a foot wound closes and stays closed. Those belong to primary care. Gateway shares wound findings with the primary care clinician and can arrange diabetes care at home with a primary care partner when that is needed.

The risk does not end when the wound closes. Ask about protective footwear and how often your feet should be checked.

Signs that need attention right away

Limb-threatening changes can move quickly. Contact the treating clinician promptly for:

Redness, warmth or swelling spreading up the foot or leg
New drainage, pus or a foul smell
Skin turning dark blue, purple or black
A new blister, sore or break in the skin on a foot with poor feeling
Fever, chills, or blood sugar that is suddenly hard to control

Call 911 for a foot or leg that suddenly turns cold, pale or numb, severe pain that comes on quickly, red streaks moving up the leg with fever, or new confusion. Gateway is not an emergency service. Our guide to diabetic foot ulcer warning signs goes further.

How to start

Patients and families can request care online or call 314-325-0126, with or without a referral. The form takes a name and phone number only.

Podiatrists, vascular practices, primary care offices and facilities can refer a patient or fax records to 314-786-7966.

Common questions

Does limb preservation mean amputation can always be avoided?

No. Limb preservation means the care team works to keep as much of the foot or leg as is safe. Sometimes removing a toe or part of a foot is what controls an infection or protects the rest of the limb. That decision belongs to the surgeon, the other treating clinicians and the patient.

Why does blood flow get checked before the wound is treated?

A wound needs blood flow to heal. If the arteries in the leg are narrowed, a wound may stall however well it is dressed, and treatments such as compression may not be suitable. Circulation testing tells the treating clinician whether a vascular specialist should be involved. Our guide to peripheral artery disease and foot wounds explains the tests.

Who is in charge when several specialists are involved?

Each clinician is responsible for their own part: the wound clinician for the wound plan, the vascular specialist for circulation, the podiatrist for foot structure and foot surgery, and primary care for overall health. Gateway does not direct care. We track what has been ordered, pass records between offices and flag appointments or results that are still outstanding.

What should I do while waiting for a first visit?

Keep following the instructions you already have, including any direction to stay off the foot, and keep the appointments already scheduled. If the wound or the foot changes in any of the ways described above, do not wait for the visit. Call your clinician, or 911 in an emergency.

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.

Limb preservation wound care in St. Louis.