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. Raffetto JD, Ligi D, Maniscalco R, et al. Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment. J Clin Med. 2020 Dec 24;10.