referral criteria from primary care - venous leg ulcer

Last reviewed 01/2018

Referral criteria from primary care- venous leg ulcer

• specialist referral should be considered in the following conditions:
• Referral before treatment:
  • an uncertain diagnosis
  • a suspected non-venous cause of ulceration:
    • arterial or mixed venous/arterial ulcer: if ABPI <0.8 refer for further assessment of arterial disease; if ABPI <0.5 refer urgently to specialist vascular clinic
    • malignant ulcer or a rapidly deteriorating ulcer. An atypical appearance or distribution of ulcers may require biopsy by dermatology
    • rheumatoid ulcer or ulcers associated with systemic vasculitis
    • diabetic ulcer or newly diagnosed diabetes in a person with an ulcer
• Referral during treatment:
  • a complication related to the ulcer or treatment
    • contact dermatitis; refer to a dermatologist for patch testing
    • cellulitis requiring intravenous antibiotics or worsening with treatment
    • pain which is uncontrolled: refer to specialist pain team
  • an unhealed or worsening ulcer after 2-3 months of standard treatment
  • recurring ulcers
  • conditions which need specialist intervention such as varicose veins, arterial insufficiency (1)

Reference:

• 1. Clinical Knowledge Summaries 2008. Leg ulcer-venous