Shaping better health
REMEDY : BNSSG referral pathways

Leg Ulcer

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






Red Flags

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.