Wound Management

Wounds of traumatic aetiology

• Systemic inflammatory response symptoms (SIRS) or clinically unwell
• Wounds with complex foreign body involvement and significant damage to associated surrounding structures including blood vessels, nerves, muscles, joints and tendons. 
• Wounds with associated compound fractures
• Persistent significant bleeding not controlled with usual measures 
• Worsening pain and/or pain not in keeping with mechanism of injury
• Initial acute burns should be managed as per ANZBA guidelines
• Refer to Vascular High Risk Foot CPC or Diabetic High Risk Foot CPC 

Arterial/ischaemic ulcer

• Systemic inflammatory response symptoms (SIRS) or clinically unwell
• Worsening pain and/or pain not in keeping with progression of the wound/ulcer
• Sepsis or acutely unwell due to infection3
• Acute or critical limb ischaemia with necrosis
• Rapidly deteriorating ulceration or necrosis.3
• Ulcers or wounds in a limb with markedly compromised circulation

Wounds on the High-Risk Foot

• Systemic inflammatory response symptoms (SIRS) or clinically unwell
• Worsening pain and/or pain not in keeping with progression of the wound/ulcer
• Progressive cellulitis despite initial treatment
• Acute or critical limb ischaemia with necrosis
• Acute Charcot arthropathy if access to podiatry is not accessible within 48 hours

Stoma related wounds

• Systemic inflammatory response symptoms (SIRS) or clinically unwell
• Worsening pain and/or pain not in keeping with progression of the wound
• Progressive cellulitis despite initial treatment
• Suspected incarcerated hernia or underlying abscess
• Suspected bowel obstruction resulting in non-functioning stoma
• Persistent significant bleeding not controlled with usual measures 
• Stomal change in colour from red / pink to blue or black
• Stomal prolapse causing circulatory compromise
• Bleeding peristomal varices
• Ongoing high output stoma and signs of dehydration

NB: If the problem is with the stomal appliance the patient can self-refer to stomal therapy nurse.  Patients not in contact with regular stomal therapy nurse/service can be referred by GP.

Pressure injury

• Systemic inflammatory response symptoms (SIRS) or clinically unwell
• Worsening pain and/or pain not in keeping with progression of the wound/ulcer
• Pressure injury if causing systemic infection
• Patients with spinal injuries should be referred to Spinal Outreach Team (SPOT)

Post-operative wound/dehiscence

• Systemic inflammatory response symptoms (SIRS) or clinically unwell
• Worsening pain and/or pain not in keeping with progression of the wound/ulcer
• Prosthesis / metal work is on view
• Purulent discharge with associated fevers