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Referral criteria from primary care - venous leg ulcer

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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)


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.

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