6 July 2026

The Tissue Viability Service is introducing an updated Lower Leg Pathway to support community teams in delivering timely, high-quality care for patients with lower limb ulceration.

The refreshed pathway provides clearer guidance, supports earlier escalation, and aims to improve patient outcomes.

Join our Q&A sessions
To support the rollout, a series of short Q&A sessions will be delivered to walk through the changes and answer any questions:

Key requirement
As part of the updated pathway, a comprehensive holistic assessment, including Ankle Brachial Pressure Index (ABPI), must be completed within two weeks of the onset of a leg ulcer, in line with national and local guidance.

What’s new?
The updated pathway encourages staff to:

  • Promote patient self-management, supporting individuals to take an active role in their care and recovery
  • Apply clear guidance for patients with heart failure, ensuring decisions around compression therapy are safe, appropriate, and patient-centred
  • Follow clearer referral triggers to ensure timely access to specialist support

Referral triggers to Tissue Viability
To ensure patients receive the right support at the right time, the pathway introduces clear escalation points:

  • At 4 weeks: If there is no improvement in tissue type or wound size despite optimal compression therapy, refer to Tissue Viability
  • At 12 weeks: If the ulcer has not healed, refer to Tissue Viability for further assessment and management

These triggers will help identify non-healing wounds earlier and reduce delays in accessing specialist input.

Please note that routine 12-week ABPI/TBPI reassessment is no longer required for community staff during an episode of care for patients with leg ulceration.

This change reduces unnecessary duplication and enables teams to focus on delivering effective, patient-centred care.

What this means for patients and staff

The updated pathway has been designed to:

  • Support earlier identification of non-healing wounds
  • Improve consistency and confidence in clinical decision-making
  • Enable faster access to specialist services
  • Reduce avoidable delays in care
  • Improve healing outcomes for patients

What you need to do
Please ensure you familiarise yourself with the updated Lower Leg Pathway and incorporate it into your clinical practice.

By working together, we can improve patient experience and achieve better outcomes across our services.

For further information, visit: yourspace.merseycare.nhs.uk/TVS  

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