Venous leg ulcer

ADULT

  • 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.

    • 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.
    • 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:

    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 hosiery
    • <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 etc
Minimum Referral Criteria
Category 1
(appointment within 30 calendar 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 calendar days)
  • No category 2 criteria
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • 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)

3. Additional referral information Useful for processing the referral

  • 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)

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    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
    • 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
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    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

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    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.)

  • 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.

    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.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 4 December 2024

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