When to refer a patient with an ulcer or wound

Specialist health practitioners and wound clinics are vital resources for wound management. Referral to these services is indicated at diagnosis or soon after (early referral) for some wound types.

Patients requiring early referral include those with:

• rapidly deteriorating wounds
• large or complex wounds
• wounds that could lead to amputation
• vascular leg ulcers (early referral for vascular intervention is strongly recommended; see Venous leg ulcers or Arterial leg ulcers)
• wounds likely to require specialised therapies (eg pressure redistribution, topical negative pressure, hyperbaric oxygen)
• wounds with atypical appearance (eg irregular edge, abnormal colour and texture of tissue) or location.

Other patients requiring referral include those with:

• wounds that are not healing despite best practice
• wounds that recur without an obvious cause
• persistent wound pain despite optimal management
• multiple comorbidities.