Wound Management

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    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.

    Wounds of uncertain cause or hard to heal ulcer

    • Systemic inflammatory response symptoms (SIRS) or clinically unwell (see Sepsis Clinical Tools)
    • Persistent significant bleeding not controlled with usual measures
    • Worsening pain and/or pain not in keeping with mechanism of injury

    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.

    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

    Stoma related wounds

    • 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
    • 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 (see Sepsis Clinical Tools)
    • Worsening pain and all pain not in keeping with current state of the wound/ulcer
    • Pressure injury causing cellulitis 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

    • If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
    • 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)

  • Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section.

  • The following are not routinely provided in a public Wound Management service.

      The following are not routinely provided in a public Wound Management Service in the first instance.

    • Initial acute burns management. These wounds should be managed as per ANZBA guidelines
    • Foot ulcers or wounds on the High Risk Foot (a.k.a. diabetic foot ulcer/disease)  are to be managed by the Statewide High Risk Foot Working Group and using,  Vascular High Risk Foot CPC or Diabetic High Risk Foot CPC.
    • Pressure injuries in patients with spinal injuries should be referred to the Spinal Outreach Team (SPOT).
    • Initial post-operative wound dehiscence.  These wounds should first be initially assessed by the involved Surgeon to exclude the need for further surgical input.
    • Malignant and /or fungating skin ulcer without tissue diagnosis.  These wounds/lesions should be managed as per Plastic & Reconstructive Surgery CPC or Dermatology CPC.

Last updated: 28 November 2024

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