Venous leg ulcer
Adult

On this page

Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

Wounds of traumatic aetiology

Systemic Inflammatory Response Symptoms (SIRS) or clinically unwell (see Sepsis Clinical Tools )
Wounds with complex foreign body involvement and significant damage to associated surrounding structures including blood vessels, nerves, muscles, joints and tendons.
Wounds with associated compound fractures
Persistent significant bleeding not controlled with usual measures
Worsening pain and/or pain not in keeping with mechanism of injury
Initial acute burns should be managed as per ANZBA guidelines
Lacerations and wounds not suitable for primary health management e.g. lip lacerations, large facial lacerations, lacerations with altered sensation, large skin defects

Arterial/ischaemic ulcer

Systemic Inflammatory Response Symptoms (SIRS) or clinically unwell (see Sepsis Clinical Tools
Worsening pain and/or pain not in keeping with progression of the wound/ulcer
Sepsis or acutely unwell due to infection3
Acute or critical limb ischaemia with necrosis
Rapidly deteriorating ulceration or necrosis.3
Ulcers or wounds in a limb with markedly compromised circulation

Wounds on the High-Risk Foot

Systemic inflammatory response symptoms (SIRS) or clinically unwell
Worsening pain and/or pain not in keeping with progression of the wound/ulcer
Progressive cellulitis despite initial treatment
Acute or critical limb ischaemia with necrosis
Acute Charcot arthropathy if access to podiatry is not accessible within 48 hours

Stoma related wounds

Systemic Inflammatory Response Symptoms (SIRS) or clinically unwell (Sepsis Clinical Tools)
Worsening pain and all pain not in keeping with current state of the wound
Progressive cellulitis despite initial treatment
Suspected incarcerated hernia or underlying abscess
Suspected bowel obstruction resulting in non-functioning stoma
Persistent significant bleeding, including peristomal varices, not controlled with usual measures
Stomal change in colour from red / pink to blue or black
Stomal prolapse causing circulatory compromise
Ongoing high output stoma and signs of dehydration

NB: If the problem is with the stomal appliance the patient can self-refer to stomal therapy nurse. Patients not in contact with regular stomal therapy nurse/service can be referred by GP.

Pressure injury

Systemic Inflammatory Response Symptoms (SIRS) or clinically unwell (Sepsis Clinical Tools)
Worsening pain and all pain not in keeping with current state of the wound
Pressure injury causing and systemic infection
Patients with spinal injuries should be referred to Spinal Outreach Team (SPOT)

Patients from Residential Aged Care Facilities can access wound advice from RADAR services (Residential Aged Care District Assessment and Referral Service) where they are established

Post-operative wound/dehiscence

Systemic Inflammatory Response Symptoms (SIRS) or clinically unwell (see Sepsis Clinical Tools )
Worsening pain and/or pain not in keeping with progression of the wound/ulcer
Prosthesis / metal work / mesh is on view/ vascular bypass procedure
Tendon blood vessel or other structure on view
Purulent discharge with associated fevers
Immunocompromised patients
Deep sinus or fistula present

Referral to Surgeon who performed operation/Surgical Clinic

Patients should have clearance from their surgeon for wound management alone if:

Acute wound dehiscence in the post operative period (< 6 weeks)

Venous leg ulcer

Systemic Inflammatory Response Symptoms (SIRS) or clinically unwell (see Sepsis Clinical Tools )
Worsening pain and/or pain not in keeping with progression of the wound/ulcer
Progressive cellulitis despite treatment – rapidly spreading cellulitis with peri-wound redness or erythema (colour change, warmth, tight oedema, or pain in pigmented skin tones) for > 2cm
Uncontrollable bleeding from ulcer

Useful Management Information

Typical Venous Leg Ulcer
- Located on lower third of lower leg and above ankle bones (malleoli)
- Ulcer is irregular shape, shallow with sloping edges and high exudate
- Surrounding skin has chronic venous insufficiency changes of combinations of brown haemosiderin staining, weeping or crusted venous stasis eczema, lipodermatosclerosis (inflamed lower leg with ‘inverted champagne bottle’ shape)

Suggestions for interim patient care while waiting specialist appointment:

Refer to HealthPathways Leg ulcers , HealthPathways T.I.M.E. Model or local guidelines on leg ulcer wound care
QUT Promoting Healthy Skin Venous Leg Ulcer Flow Chart
QUT Promoting Healthy Skin Venous Leg Ulcer Assessment
QUT Promoting Healthy Venous Leg Ulcer Management
QUT Promoting Healthy Skin Venous Leg Ulcer Prevention

Lower Leg Compression Strength from various methods:

Mild compression (< 20mmHg) – not enough compression for treatment of VLU’s

<10mmHg – TED anti-embolic (white) stocking, Tubifast type retention sleeves (Blue and Yellow line size
10 -14 mmHg - light compression sleeves per layer e.g. Tubigrip/Versagrip/ Tubulaform etc
14 -17mmHg CCl I hoiseryhosiery
<15mmHg - Light crepe bandage, slight extension
15 – 20 mmHg – Class I hosiery

Medium compression (20 mmHg to <40mmHg) – beneficial in treatment of VLU’s

18-24 mmHg – Profore lite, Coban 2 Lite, Compri 2 lite etc
20 -25 mmHg – Class II hosiery
30 -35 mmHg - Short stretch inelastic bandage e.g. Comprilan, Putterbinde; Long stretch bandage e.g. Setopress, Surpress, Class III hosiery

Strong compression (>40mmHg) - Gold Standard treatment of VLU’s

35 -40 mmHg – multi layer elasticised bandage e.g. Profore bandage, Coban 2, Compri 2, Urgo K

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 days)	If 2 weeks of 24/7 firm graduated toes to knee compression (20-30mmHg) over an occlusive dressing does not produce 25% reduction in wound surface area If above pressure dressing unachievable Aetiologic complexity – venous disease + other comorbidity Patients fit for surgery should be referred as per Vascular CPC for Venous Disease
Category 2 (appointment within 90 days)	No category 2 criteria
Category 3 (appointment within 365 days)	No category 3 criteria
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

Reason for request

To establish a diagnosis
For treatment or intervention
For advice and management
For specialist to take over management
Reassurance for GP/second opinion
For a specified test/investigation the GP can't order, or the patient can't afford or access
Reassurance for the patient/family
For other reason (e.g. rapidly accelerating disease progression)
Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

Presenting symptoms (evolution and duration)
Physical findings
Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

Willingness to have surgery (where surgery is a likely intervention)
Choice to be treated as a public or private patient
Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential Referral Information

Co-morbidities, past medical history,
Wound history e.g. duration, description, and size, wound initiating event
Signs of lower limb venous system disease – varicosities, oedema, haemosiderin staining, lipodermatosclerosis
Peripheral arterial perfusion basic assessment – leg pulses, recumbent capillary return time
Investigations (if performed) e.g.
- wound biopsies
- arterial studies / Ankle Brachial Pressure Index
- venous incompetence studies (note NOT venous ultrasound for acute DVT)
Details of all treatments offered, and efficacy to date e.g. specific current and past types of wound dressings and leg compression used, date of commencement of any antibiotics with dose prescribed.
Service provider (i.e. GP, practice nurse or domiciliary nursing service)

Additional Referral Information

Recent wound swabs, latest blood tests (ELFT’s, FBC)
Residential status (lives alone, support networks, etc)
My Aged Care or NDIS participation
Smoking status
Nutritional status / dietary intake / serum albumin
HbA1c / blood sugar control (if patient has diabetes)

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

(E-Blueslips)

Fax

(07) 5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Venous leg ulcerAdult