Wound Care Conditions We Treat

Diabetic Foot Ulcers

What Are Diabetic Foot Ulcers?

Diabetic foot ulcers are open wounds that develop on the feet of people living with diabetes. They are one of the most common and serious complications of diabetes, affecting roughly 15% of people with diabetes at some point in their lives. These ulcers form when a combination of diabetic neuropathy (nerve damage that reduces sensation in the feet), peripheral vascular disease (reduced blood flow to the extremities), and structural foot deformities create conditions that make the feet vulnerable to injury. Because patients often cannot feel the pain of a developing wound, diabetic foot ulcers can go unnoticed until they become severe.

Risk Factors and Complications

Risk factors for diabetic foot ulcers include poorly controlled blood sugar, peripheral neuropathy, poor circulation, a history of previous ulcers, foot deformities such as bunions or hammertoes, and improper footwear. Without timely, expert wound care, diabetic foot ulcers can lead to serious infections, osteomyelitis (bone infection), and in the worst cases, lower limb amputation. In fact, diabetic foot ulcers precede roughly 85% of diabetes-related amputations, which is why early intervention by a wound care specialist is so important.

How Gateway Wound Care Treats Diabetic Foot Ulcers

Our approach to diabetic foot ulcer treatment in St. Louis begins with a thorough assessment of the wound, your circulation, sensation, and overall foot health. We provide professional wound debridement to remove dead tissue, select advanced wound dressings matched to your wound's needs, implement offloading strategies to relieve pressure on the ulcer, and monitor closely for signs of infection. We coordinate with your primary care physician and endocrinologist to ensure your diabetes management supports wound healing. We also educate patients and families on daily foot inspection, proper footwear, and signs of infection that need immediate attention.

Why Mobile Wound Care Helps

For patients with diabetes, mobility can be limited and transportation to a clinic is often difficult. Mobile wound care eliminates that barrier. Our specialists come to your home or facility, reducing the risk of further foot injury from travel and making it easier to maintain consistent treatment visits. Consistent, regular wound care is the single most important factor in healing a diabetic foot ulcer and preventing amputation.

Venous Leg Ulcers

What Are Venous Leg Ulcers?

Venous leg ulcers are chronic wounds that develop on the lower legs, most often near the inner ankle. They are caused by chronic venous insufficiency, a condition in which damaged or weakened valves in the leg veins fail to efficiently return blood to the heart. When blood pools in the lower legs, the sustained pressure damages skin and underlying tissues over time, eventually leading to an open wound. Venous ulcers account for the majority of all leg ulcers and can persist for months or even years without proper treatment.

Symptoms and Diagnosis

Venous leg ulcers typically appear as shallow, irregularly shaped wounds surrounded by discolored, hardened skin. The affected leg is often swollen, and patients may notice aching, heaviness, or itching in the leg before the ulcer develops. The wound itself often produces a significant amount of drainage. Proper diagnosis involves assessing venous function, and we may recommend vascular testing such as an ankle-brachial index (ABI) to confirm that arterial blood flow is adequate before beginning compression therapy.

Treatment Approach: Compression Therapy

Compression therapy is the gold standard treatment for venous leg ulcers. By applying controlled external pressure to the leg, compression helps damaged veins return blood more efficiently and reduces the swelling that impairs healing. Our specialists select the appropriate compression system based on your vascular status, wound characteristics, and comfort needs. We combine compression with evidence-based wound dressings, gentle debridement when needed, and management of surrounding skin changes. Most venous leg ulcers respond well to consistent compression therapy, though healing may take several weeks to months depending on the ulcer's size and duration.

Why Mobile Wound Care Helps

Patients with venous leg ulcers benefit enormously from regular, consistent treatment. Our mobile wound care model makes it easy to maintain the frequent visits that venous ulcers require, and our specialists ensure that compression is applied correctly every time. Proper compression application is a skill that requires training, and getting it right makes a significant difference in healing time.

Pressure Ulcers and Bedsores

What Are Pressure Ulcers?

Pressure ulcers, also known as bedsores or decubitus ulcers, are injuries to the skin and underlying tissue caused by prolonged pressure on the skin. They most commonly develop over bony prominences such as the sacrum (tailbone), heels, hips, and shoulder blades. Pressure ulcers are especially common in people with limited mobility, including those who are bedridden, wheelchair-bound, or recovering from surgery. Poor nutrition, incontinence, and reduced sensation also increase risk.

Staging: Understanding Pressure Ulcer Severity

Pressure ulcers are classified by stage depending on the depth of tissue damage:

• Stage 1: Intact skin with a localized area of non-blanchable redness. The area may be painful, firm, or warmer than surrounding skin. This is the earliest warning sign and the most treatable stage.
• Stage 2: Partial-thickness skin loss involving the outer skin layer (epidermis) and sometimes the dermis. The ulcer appears as a shallow open wound or fluid-filled blister.
• Stage 3: Full-thickness skin loss. The wound extends through the full skin layer into subcutaneous fat but does not expose bone, tendon, or muscle. The ulcer may appear as a deep crater.
• Stage 4: Full-thickness tissue loss with exposed bone, tendon, or muscle. Stage 4 pressure ulcers carry significant risk of osteomyelitis (bone infection) and other life-threatening complications.

There are also unstageable pressure ulcers (where dead tissue obscures the wound base) and deep tissue injuries (where damage starts beneath intact skin). Accurate staging by a wound care specialist is essential for proper treatment planning.

Treatment by Stage

Stage 1 and Stage 2 pressure ulcers often respond well to pressure relief, repositioning, proper nutrition, and appropriate wound care. Stages 3 and 4 require more intensive treatment including professional debridement, advanced wound dressings, infection management, and in some cases negative pressure wound therapy (wound vac). Regardless of stage, prevention of further pressure damage through repositioning, support surfaces, and nutrition optimization is always part of the treatment plan.

Prevention and Caregiver Education

Prevention is critical, especially for patients at ongoing risk. Our specialists work with patients, families, and facility staff on regular turning and repositioning schedules, proper support surface selection (specialized mattresses and cushions), skin care routines, nutrition for wound healing, and recognizing early warning signs. For patients in skilled nursing facilities and assisted living communities, we partner with nursing staff to develop and reinforce prevention protocols.

Arterial Ulcers

What Are Arterial Ulcers?

Arterial ulcers, also called ischemic ulcers, develop when inadequate arterial blood flow to the legs and feet deprives tissues of the oxygen and nutrients they need to stay healthy. These wounds are most commonly associated with peripheral arterial disease (PAD), a condition in which the arteries that supply blood to the extremities become narrowed or blocked by atherosclerosis. Arterial ulcers typically appear on the lower legs, ankles, heels, and toes, and they are often very painful.

Symptoms and Warning Signs

Arterial ulcers have a distinct appearance: they tend to have well-defined edges, a pale or grayish wound bed, and minimal drainage. The surrounding skin may be cool, pale, or shiny, and patients often report pain that worsens when the legs are elevated and improves when dangling. Other signs of arterial insufficiency include weak or absent pulses in the feet, delayed capillary refill, and leg pain during walking (claudication). If you notice any of these symptoms, seeking wound care evaluation promptly is important because arterial ulcers carry significant risk of tissue loss and limb compromise.

Treatment Approach

Because arterial ulcers result from reduced blood flow, effective treatment requires addressing the vascular problem in addition to caring for the wound itself. Our wound care specialists coordinate closely with vascular surgeons and interventional cardiologists to optimize blood flow. Locally, we provide careful wound assessment, gentle debridement when appropriate, infection prevention, pain management, and specialized dressing selection that protects fragile tissue. Compression therapy is generally not appropriate for arterial ulcers, which is why accurate diagnosis and vascular assessment are so important.

When to Seek Care

If you have a wound on your leg or foot that is not healing, especially if you have a history of peripheral vascular disease, diabetes, or smoking, it is important to have it evaluated by a wound care specialist. Arterial ulcers can worsen rapidly, and early treatment significantly improves outcomes. Call Gateway Wound Care at (314) 804-8364 to schedule an assessment.

Surgical Wound Complications

When Surgical Wounds Do Not Heal as Expected

Most surgical incisions heal without problems when patients follow their post-operative care instructions. However, some patients develop complications including wound dehiscence (separation of the wound edges), delayed healing, surgical site infection, or formation of a seroma or hematoma. Risk factors for surgical wound complications include diabetes, obesity, smoking, poor nutrition, immunosuppression, and certain medications. Patients who have had abdominal, orthopedic, vascular, or cardiac surgery are among those who may develop post-operative wound issues.

Signs That a Surgical Wound Needs Expert Attention

Contact your surgeon or a wound care specialist if you notice any of the following signs after surgery:

• The wound edges are separating or pulling apart
• Increasing redness, swelling, or warmth around the incision
• Drainage that is cloudy, foul smelling, or increasing in volume
• Fever or chills
• The wound does not appear to be improving after two weeks

Early intervention by a wound care specialist can prevent minor complications from becoming major problems, reduce the chance of hospital readmission, and help patients heal safely at home.

How Gateway Wound Care Helps

Our specialists manage complicated post-operative wounds using evidence-based techniques including wound debridement, advanced wound dressings, negative pressure wound therapy when appropriate, and close monitoring for infection. We communicate with your surgeon about wound progress and any changes in treatment. For patients who need ongoing wound care after hospital discharge, we provide a smooth transition from hospital to home wound management. Healthcare providers can refer patients for post-surgical wound care by calling (314) 804-8364.

Burns and Thermal Injuries

Burn Wound Management

Burns are injuries to the skin caused by heat, flames, steam, hot liquids, chemicals, or electrical contact. They are classified by depth: first-degree burns affect only the outer layer of skin, second-degree burns extend into the dermis, and third-degree or fourth-degree burns involve full-thickness tissue destruction. Burn wound management is complex and requires specialized knowledge to prevent infection, promote healing, manage pain, and minimize scarring and loss of function.

When Home Wound Care Is Appropriate for Burns

Serious burns require initial treatment in a hospital or burn center. However, once the acute phase has passed, many patients can continue their recovery with mobile wound care at home. Gateway Wound Care provides skilled burn wound management including gentle wound cleansing and debridement, specialized burn dressings, infection monitoring and prevention, scar management, and patient education about wound care between visits. We coordinate with your burn surgeon or emergency physician to ensure continuity of care.

Traumatic Wounds

Complex Wounds from Accidents and Injuries

Traumatic wounds result from accidents, falls, lacerations, crush injuries, animal bites, and other forms of physical trauma. These wounds are often irregular, may involve contamination or foreign material, and can include damage to deeper structures like tendons, nerves, or blood vessels. Proper assessment and ongoing wound care are essential for optimal healing and return of function.

Treatment Approach

After initial emergency treatment, many traumatic wounds benefit from ongoing professional wound care. Our specialists provide thorough wound assessment, removal of devitalized tissue, infection prevention and management, specialized dressing selection, and close monitoring for complications. We manage lacerations, abrasions, crush injuries, degloving injuries, and other complex traumatic wounds in the comfort of your home or facility. By providing expert wound care outside of the hospital setting, we help patients avoid unnecessary return visits while ensuring their wounds heal properly.

If you or a loved one has a wound that is not healing as expected, or if you have been discharged from the hospital with a wound that needs ongoing care, call Gateway Wound Care at (314) 804-8364. We are here to help.