Referral to emergency
If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
- suspected deep tissue infection (presence of bullae, necrosis or subcutaneous emphysema)
- suspected necrotising fasciitis
- underlying vascular or tendon injury
- hand infections - fingertip, flexor tendon infection, abscess
- bites: animal and human
- skin threating injury e.g. haematoma, large skin tear
- soft tissue loss greater than 5cm2
- uncontrolled pain after analgesia
- numbness, weakness or lack of perfusion distal to injury
- lack of systemic or local response to oral antibiotics
- systemic features including:
- febrile greater than 380
- haemodynamic instability
- positive blood cultures
- rising or unchanging C-reactive protein (CRP) or white cell count (WCC) unresponsive to antibiotics
For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Central Adelaide Local Health Network
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
- ischaemic ulcers – non palpable pulses/ankle brachial pressure index (ABPI) less than or equal to 0.85 – refer to Peripheral Artery Disease (PAD) CPC
- diabetic ‘high-risk’ foot ulcers – refer to High-risk foot CPC
- venous ulcers ultrasound (US) confirmed – refer to Varicose Veins / Venous Disease CPC
- acute/chronic burns – refer to Acute burns CPC
Category 1 - appointment clinically indicated within 30 days
- post op wound dehiscence - where surgeon is unavailable locally, or person is not able to return for other reasons e.g. financial (within South Australia)
- delayed presentation soft tissue laceration/s without systemic features or rapidly progressing infection responsive to antibiotics
- contaminated non-healing wound present for greater than 4 weeks
Please consider contacting your nearest plastic and reconstructive surgery service prior to referral to ensure prompt review.
Category 2 — appointment clinically indicated within 90 days
- uncontaminated non-healing wound present for greater than 4 weeks
Category 3 — appointment clinically indicated within 365 days
For information on referral forms and how to import them, please view general referral information.
Essential referral information
Completion required before first appointment to ensure patients are ready for care. 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.
- identifies as Aboriginal and/or Torres Strait Islander
- identify within your referral if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter requirements
- past medical/surgical history including bariatric surgery date and outcomes
- current medication list – especially immunosuppressants; steroids, anti-platelet, non-vitamin k antagonist oral anticoagulants (NOACs), or warfarin
- allergies and sensitivities – including topical application/dressings
- clinical assessment of wounds including:
- onset and duration
- associated features, e.g. size, shape, colour, inflammation, oozing, change in sensation, bleeding
- T.I.M.E wound assessment tool
- where lower limb involvement exists:
- presence of pulses
- ankle brachial pressure index (ABPI)
- treatment or management trialled including:
- hand/finger splints
- abdominal binders
- compression therapy
- community services in place and current management plan e.g. community nursing visits 3 times a week including dressing management plan and efficacy
- punch biopsy results in wounds present for greater than 12 weeks
- relevant investigations and reports e.g. arterial/venous ultrasound (US) or wound biopsy
Additional information to assist triage categorisation
- photograph including disposable measurement tool – with patient’s consent, where secure image transfer, identification and storage is possible
Clinical management advice
Please note that non- healing wound referrals can be managed by the following specialist services:
- burn service (burn wounds)
- plastic surgery
- vascular (diabetic/high-risk foot, ischaemic, mixed, or venous ulcers)
A chronic wound is one that has failed to progress through the phases of healing in an orderly and timely fashion and has shown no significant progress toward healing in 30 days. Factors contributing to the chronicity of the wound may include:
- increased bacterial load
- systemic issues such as poorly controlled diabetes, peripheral oedema, poor circulation, malnutrition
- inappropriate frequency/management/treatment regime
- radiation therapy.
Patients with a chronic wound should be screened for malnutrition utilising the Malnutrition Universal Screening Tool (MUST).
Consider the use of compression therapy and limb elevation for leg and foot wounds if ankle brachial pressure index allows (metropolitan referral unit may be able to assist with this).
For wound dehiscence please contact the surgeon who performed the original procedure for assessment and management, where possible.
Non-healing lower limbs ulcers wounds greater than 4 weeks old and unresponsive to treatment, please consider the following:
- peripheral artery disease
- ankle brachial pressure index (ABPI) if unable to palpate lower limb pulses.
- for ABPI equal to or less than 0.85 – consider referral to Peripheral Artery Disease (PAD) - Adult CPC.
- venous incompetence
- a venous incompetency ultrasound (US) will assist in identifying suitable treatment for these people.
- best treatment for venous ulceration remains compression therapy.
- alternative treatments may be suitable for some people with venous ulcers – consider referral to Varicose Veins / Venous Disease - Adult CPC if superficial incompetency is confirmed on the affected limb through US.
Consider screening and/or optimisation of diabetes.
It is strongly recommended that people who smoke or vape stop 3 months prior to consultation. Smoking/vaping is associated with delayed healing. Please refer to useful resources section for further information.
Patients with body mass index (BMI) greater than or equal to 35 should be counselled around weight loss management. Please refer to Clinical management advice and resources for further information.
If the patient requires urgent attention and/or fulfils category 1 triage criteria, please contact the on-call registrar to discuss and ensure your referral has been received.
- BAPEN – MUST Screening Tool
- Wounds Australia - Australian Wound Management Association Assessment Flow Chart for Venous Leg Ulcers
- Central Adelaide Local Health Network – PreHab: Getting Ready for Surgery
- SA Health - Country Referral Unit
- Therapeutic Guidelines - Factors Affecting Ulcer and Wound Healing
- SA Health - Metropolitan Referral Unit
- Wound Source - T.I.M.E. Wound Assessment Tool
- Wounds Australia - Publications