Checked: 06-11-2017 by
Rob.Adams Next Review: 05-11-2018
Principles of Management
Local clinicians recommend the Leg ulcer clinical guidance provided by the Primary Care Dermatology Society.
Bristol Community Health provide a nurse led Wound Care Service and can provide support for practice nurses and district nurses who are managing difficult wounds and leg ulcers. There is a referrers guide and referral form on the weblink. There is also the Podiatry Service for patient with foot ulcers who are at moderate/high risk. The links have referral guidelines and referral forms as well as contact details.
Venous leg ulcers that are associated with varicose veins can be referred to vascular surgeons but only after failed conservative treatment and prior approval has been obtained. See link to the Varicose Vein INNF policy.
Patients with low ABPIs/suspected arterial ulcers should be referred to the vascular surgeons via e-referral. There is a vascular hot clinic for more urgent concerns (e.g. infected diabetic leg or foot ulcers with vascular compromise) . Urgent patients can be referred via the vascular network office telephone 0117 414 0798 or by discussion with either the General Surgery/Vascular Surgery Registrar on call.
Patients with non-vascular leg ulceration that are not responding to treatment in primary care can be referred to the general dermatology clinics via e-referral
Referral must be considered in the following cases:
- Venous ulcers failing to progress at three months or which have not healed by twelve months
- All ulcers of an arterial or mixed aetiology -assessment needed for reconstructive surgical / radiological procedures
- All diabetic and rheumatoid ulcers
- Failure to adequately control underlying pathologies
- Suspected malignant change (refer urgently as a 2 Week Rule to dermatology)
- Suspected cases of contact allergic dermatitis
- Post-healing -consideration should be given to referral for further investigations of venous leg ulcers to see if surgical intervention would reduce the risk of re-ulceration. Such a referral would depend on local resources, and is particularly relevant for patients developing ulcers from a young age.
If malignant change in an ulcer is suspected then refer to dermatology 2WW pathway
Diabetes Foot Pathway- Bristol
There is a local diabetes foot pathway which includes advice on when and how to refer patients who have diabetes and foot ulcers.