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Assess for presence of red flag symptoms and book into full assessment appointment within 2 weeks.
Distal ulceration or gangrene with:
Rapidly progressing ulcer or rolled edges
Consider dermatology referral
Urgent discussion with vascular team
Cellulitis (Cellulitis guideline)
Ulceration in someone who has diabetes has the potential to become limb or life threatening very rapidly - refer to Cellulitis guidelines
Complete leg wound assessment form
Full assessment - Complete leg wound assessment proforma and review red flags
Do ABPI and Clinical assessments match, if yes and venous and ABPI 0.80-1.30
Compress and follow dressing as per North and East Formulary - wound management
Undertake six weekly formal assessment of progress.
Wound is improving (Should be measurable and ongoing reduction in wound size, wound bed, level of pain)
If wound has healed (most heal in 12 to 24 weeks)
Long term prevention
Wound not improving (swabs or antibiotics are not indicated if no evidence of cellulitis) consider the following:
Consider contact dermatitis
Patch testing can help give specific information on what substances they are allergic to.
Consider dermatology referral or topical steriods (Use steroid ointment not cream. Consider different dressings)
In all other cases discuss with appropriate service - If asymptomatic consider starting reduced compression in mixed disease and dressings as per North and East Devon Formulary - wound management.Follow clinic advice for dressings where appropriate.
If the clinical assessment and ABPI do not match - Note ABPI unreliable in diabetes
Complete leg wound assessment proforma (Including ABPI), with referral letter and send to appropriate service.
Contact details for the vascular team:- For Urgent referrals fax to 01271 335917
Weekdays contact vascular surgery secretaries to arrange discussion with vascular surgical consultant
Tel:- 01271 322424 or 01271 322423
Weekends discuss with on call surgical team. Call NDDH switchboard 01271 322577 and ask for the on call surgical team
Contact details for Tissue Viablity• Northern Devon Healthcare Trust 01271 322577,
Fax 01271 311756 email: email@example.com
Referral to orthotist
Referral to Podiatry