What criteria should I use to determine whether a patient with a wound requires referral to a specialist?

Criteria for referral of a patient with a wound to a specialist include:

• Delayed or no healing of a venous leg ulcer after 2 weeks of appropriate compression therapy applied by a trained healthcare professional, warranting referral to a vascular specialist or dermatologist depending on clinical judgement ¹.
• Presence of leg ulcers suspected to be of arterial or mixed aetiology, which should be referred to a vascular surgeon ¹.
• Diabetic ulcers require referral to a diabetes clinic for specialist management ¹.
• Younger patients with leg ulcers may benefit from vascular surgical assessment to evaluate the potential for surgical intervention to reduce re-ulceration risk ¹.
• Wounds with suspected infection that fail to respond to initial treatment or show signs of cellulitis may require specialist input, including antibiotic management and wound care advice ⁵.
• Wounds suspected to be malignant or with features raising suspicion of cancer should be referred urgently within 1 working day to a cancer service ⁶.
• In children with atopic eczema (a type of wound/skin condition), referral is indicated if diagnosis is uncertain, management is unsatisfactory, or if there are significant psychosocial impacts or complications such as severe infections ⁷.
• For wounds caused by bites, referral urgency depends on clinical judgement, especially if there is significant vascular or neurological involvement, or if the patient is at risk of tetanus or blood-borne viruses requiring specialist prophylaxis ²,³,⁴.