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Arterial/ischaemic leg ulcer

Emergency department referrals

All urgent cases must be discussed with the on-call Registrar to obtain appropriate prioritisation and treatment. Contact through

  • Caboolture Hospital (07) 5433 8888
  • Redcliffe Hospital (07) 3883 7777
  • Royal Brisbane and Women’s Hospital (07) 3646 8111
  • The Prince Charles Hospital (07) 3139 4000

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

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
  • Sepsis or acutely unwell due to infection
  • Acute or critical limb ischaemia with necrosis
  • Rapidly deteriorating ulceration or necrosis
  • Ulcers or wounds in a limb with markedly compromised circulation

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Non healing ulceration with no reduction in size despite maximal medical management of comorbidities for 2 weeks
  • Leg ulcer with signs and symptoms of chronic ischemia

Patients with significant arterial insufficiency need Vascular surgery review to determine suitability for intervention to improve arterial perfusion. If no surgical option patient’s wound/s will be assessed for a palliative management plan by Chronic Wound Service.

Category 2

Appointment within 90 days is desirable

  • No category 2 criteria

Category 3

Appointment within 365 days is desirable

  • No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

Typical Arterial/ischaemic leg ulcer:

  • Located on anterior shin surface of lower leg, foot below ankle bones (malleoli), over the toes
  • Punched out wound edges
  • Painful, aggravated by foot elevation, reduced by lowering below heart
  • May have mummified black eschar in wound bed or mummified black toes
  • Surrounding skin atrophic – thin, shiny hairless
  • Dystrophic toe nails
  • Cool skin

Suggestions for interim patient care while waiting specialist appointment:

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Wound history, location, and outcome of Vascular Surgery review
  • Co-morbidities and past medical history
  • Details of all treatments offered, and efficacy to date e.g. type of dressings used, date of commencement of any antibiotics with dose prescribed.

Additional Referral Information (Useful for processing the referral)

  • History of allergies and list of current medications
  • Current podiatry treatment/dressing regimen
  • Relevant pathology (as clinically indicated)
  • Recent vascular imaging (duplex studies, ABPI if already completed)
  • Relevant medical imaging results if available – e.g. x-ray, ultrasound
  • Clinical photograph – with patient’s consent, where secure image transfer, identification and storage is possible

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • 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

  • 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

  • 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

  • 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

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

  • 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.)
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