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Leg ulcer – Information for GPs

Referral criteria / commissioning position

Referral if appropriate:

Refer to vascular surgeon:

  • if ABPI<0.8 (urgent if ABPI<0.5) for assessment of arterial disease
  • if patient may benefit from venous surgery
  • Refer to dermatology:
  • if ulcer failing to progress at 3 months and not healed at 12 months
  • if suspected vasculitic ulcer
  • under 2 week rule if suspected malignant ulcer
  • if diagnosis uncertain

Refer to general surgery:

  • if patient may benefit from skin grafting
  • Refer urgently to Diabetic clinic/podiatry any foot ulcer in a patient with diabetes

Red flag symptoms

  • Exclude malignancy if ulcer not healing after 12 weeks.
  • Bleeding, overgrowth at edge of ulcer and unusual sites are suggestive of malignancy
  • Consider pyoderma gangrenosum or vasculitic ulcer if purple raised edge, painful, unusual site and associated underlying conditions

Investigations prior to referral

  • ABPI measurement to exclude arterial disease and ensure safe to use compression
  • Skin swab only if infection suspected

Information to include in referral letter

  • How long ulcer has been there
  • What treatments have been tried and for how long
  • The appearance of the ulcer edge e.g. shallow, punched out
  • The base of the ulcer e.g. granulating sloughy
  • The site of the ulcer e.g. medial, lateral, anterior, posterior
  • A photograph is desirable
  • ABPI measurements
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

Patient information


Very good information and pictures by Primary Care Dermatology Society

Lots of information describing the different types and causes of ulcers and management.

Good practical management of leg ulcers and when to refer on website

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