When should I consider referring a patient with a pressure ulcer to a specialist for further management?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Consider referring a patient with a pressure ulcer to a specialist for further management if:

  • There is clinical evidence of systemic infection such as systemic sepsis, spreading cellulitis, or underlying osteomyelitis requiring systemic antibiotics, which should be guided by microbiology advice ,.
  • The pressure ulcer is not healing or is worsening despite appropriate initial management, including pressure relief, wound care, and nutritional support ,.
  • The ulcer is complex, large, or deep (Category III or IV), or there is significant necrotic tissue requiring specialist assessment for possible debridement ,.
  • The patient has comorbidities or factors complicating management, such as impaired mobility, neurological impairment, or vascular insufficiency, which may require multidisciplinary input ,.
  • There is a need for advanced wound care techniques or devices not available in primary care, such as dynamic support surfaces or specialist dressings ,.
  • There is uncertainty about diagnosis, or the ulcer may have an atypical cause requiring specialist assessment (e.g., dermatology or vascular specialist) ,.

Referral pathways should be based on local resources and expertise, with involvement of tissue viability nurses, dietitians, microbiologists, and other specialists as appropriate ,.

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