Tissue Viability

What we do

Top left to bottom right: Helen, Penny, Ana-Faye, Fran, Kay, Martha, Lauren, Ger

The Tissue Viability service provides specialist advice and support to healthcare professionals who are managing complex wounds within the community of Oxfordshire.

The nurse-led team works in partnership with patients, their carers and healthcare professionals to provide expert wound care advice, specialist healthcare equipment and education that is aimed at preventing needless skin breakdown.

The team aims to improve and support high standards of practice through clinical consultations, regular audits, development of guidelines and polices and by delivering formal educational training to healthcare professionals.

Tissue_Viability_Service leaflet (pdf)

Useful information

TV team baseYou can contact the Tissue Viability Service by telephone, fax, email or post, Monday to Friday 8.30am-4.30pm.

We are based in the Admin building at Abingdon Community Hospital and our address is:

Tissue Viability
Administration Building
Abingdon Community Hospital
Marcham Road
OX14 1AG

Phone:  01865 904 959 or 90 4271

Messages can be left on our answerphones.

Email: tissueviability@oxfordhealth.nhs.uk for clinicians using Oxford Health email

Or        tissueviabilityadmin@oxfordhealth.nhs.uk for referral forms


Seeking Advice from  the Tissue Viability Team
Step 1. If you have a general query about dressings, treatment pathways, equipment provision etc, there is a wealth of information on this website which is designed to help you with your clinical decision making.

Step 2. If the information you need is not here, contact your Tissue Viability Resource Nurse (ReN), or a more experienced colleague. ReNs have had additional training from the TV team and so may be able to advise you.

Step 3. If your query cannot be answered by the above, you should email the TV team. When your email is delivered to the TV team inbox, you will receive an ‘out of office’ reply that states the email has been received. If you do not get this, the email has not arrived and therefore, you should resend it.

Step 4. If you are with the patient and discover something serious that needs immediate advice and guidance, or there is a sudden deterioration in a patient you have emailed about you should ring the team administrator on 01865 904959/ 904271. Please do not ring in with routine queries; you will be redirected to our email service.

Step 5. Tissue Viability Referral – This should be submitted when the plan of care that has been implemented following the assessment, is not progressing as expected. This form includes referrals for complex wounds, chronic oedema, skin problems and pressure damage problems associated with seating and posture. You should only complete the section(s) that apply to your patient. If requesting equipment, you will need to complete a separate equipment request form.

Patients can be referred by their GP, community nurse or any other health care professional.

We do not accept referrals from patients directly. Referrals for advice on wound care should be made using the tissue viability referral form. The Tissue Viability Service referral process guidance  and TV referral pathway guides will help you identify when and how to refer to us.

Referrals for equipment should be made using the equipment request form

Referral forms should NO LONGER be faxed to the team but should instead be emailed to our referrals email address: tissueviabilityadmin@oxfordhealth.nhs.uk. We no longer have an nhs.net email address.

All referrals should accompanied by a medical summary printout and digital photographs of the wounds.


Identifying the correct piece of equipment for a patient can be complex. The Tissue Viability Team deals with advice and guidance for clinicians regarding equipment for tissue viability purposes only. Equipment required for functional or health reasons are not sourced through our team. Refer to an occupational therapist for functional need or contact the nursing staff for a health need.

Quattro Plus - system (cut-out)The following guidance documents are provided to assist clinicians in decisions around the provision of equipment.

Guidance on Prescribing Equipment

The previous versions of the Mattress selection guide, cushion selection guide and Guide to heel protectors have now been amalgamated into the’ Pressure Ulcer Equipment Formulary (Adults: A guide for clinicians’ and can be found at the back of this document.

Once supplied, it’s important that equipment is set up correctly. Many pieces of equipment will be set up by Millbrook on delivery. It is the prescriber’s responsibility to make sure they are correctly set up and are regularly checked to monitor this. The following guides may be helpful:

If you require any further help please do contact our equipment nurse on 01865 904003.

Advice sheets for a power cut

Before supplying a piece of powered equipment consideration should be made of the impact a power cut would have if the equipment was in use. Please consult the following documents to aid decision making:

The following leaflets provide advice on particular pieces of equipment and action to be taken in the event of a power cut:


We offer a comprehensive programme of training courses which are free for Oxford Health staff. These courses are also open to other staff groups such as practice nurses and nurses working within nursing homes but incur a charge. Please email Learning & Development at learn@oxfordhealth.nhs.uk  for further information

We are pleased to announce that the 2022 Tissue Viabilty Training Program will return in the main, to Face-to-face training. A summary of the program is available in the link below.

We are running the following courses:

If possible, we would recommend attending these courses in the order they are listed, as each course, to some extent builds on previous courses.

Videos from our virtual training program are now available on a separate Tab on this site. These are an additional resource but will not count as attendance on the above courses.

Oxford Health staff – please book on via Learning & Development Portal

NON-Oxford Health staff  – please book on via email  to Learning & Development  –

Introduction and core tissue viability modules

This consists of 4 videos for delegates to watch and are compulsory viewing for any of the following TV courses. Once they have been watched once they do not need to be watched again.

  • Introduction
  • Partnership working – Patient concordance and motivational interviewing
  • Holistic patient assessment (Tissue Viability)
  • Nutrition for wound healing & pressure ulcer prevention
Wound prevention, assessment and management

This will comprise of the following videos for delegates to watch:

  • Introduction and core tissue viability modules (unless already completed)
  • Using TIMES for wound assessment & management –
  • Assessment & management of Wound Pain
  • Wound Management Formulary

Also, a live 1 hr interactive Microsoft Teams session for delegates to book onto, to assist in application of the theory in the videos into practice. Max 20 delegates

Pressure ulcer prevention, management and equipment awareness

This course is aimed at all clinicians, both registered and non-registered, working with patients. The core aims and objectives of the session are for clinicians to receive the knowledge and skills to be able to:

  • Recognise the risk factors associated with pressure damage
  • Demonstrate competence in undertaking an accurate risk assessment using the BRADEN tool
  • Take the appropriate action to help prevent or reduce the risk
  • Develop holistic care plans in the prevention and management of pressure damage
  • Understand the role equipment plays in pressure damage prevention and how equipment as part of a management plan can assist in healing pressure damage
  • To assist Clinicians understand the different types of equipment available and how to order equipment efficiently as per local guidelines
  • To assist clinicians to understand risks associated with equipment and how to reduce them

This will comprise of the following videos for delegates to watch:

  • Introduction and core tissue viability modules (unless already completed)
  • Pressure ulcer risk assessment and categorisation
  • Using SSKIN bundle for assessing & Managing PU
  • Equipment formulary

Also, a live 1 hour interactive Microsoft Teams session for delegates to book onto, to assist in application of the theory in the videos into practice. Max 20 delegates


A pressure ulcer prevention e-learning course is available via this link

Fundamentals of leg ulcer management

It is recommended that you attend the Wound Prevention, Assessment and Management study day before the FLUM days as wound management, measurement and dressing selection is not covered in any detail.

This course is aimed at all clinicians involved in the management of patients with leg ulceration and includes both registered and non-registered nurses.

This will comprise of the following videos to watch:

  • Introduction and core tissue viability modules (unless already completed)
  • Holistic lower limb assessment
  • Using a pathway approach for managing leg ulcers
  • Fundamentals of compression

Also, a live 1 hr interactive Microsoft Teams session for delegates to book onto, to assist in application of the theory in the videos into practice. Max 20 delegates

Delegates will also need to attend a small group face to face practical skills 2 hr training sessions including:

  • Compression bandaging for venous leg ulcers
  • Doppler and Lower limb assessment

DELEGATES ARE REQUESTED TO BOOK A WORKSHOP TAKING PLACE WITHIN THEIR LOCALITY IF AT ALL POSSIBLE and are requested to come prepared to practice these 2 practical procedures on each other and to bring a handheld doppler (not an automated one) with them.

Chronic oedema study day

This one-day course is open to all clinicians involved in the management of chronic oedema, both registered and non-registered. It covers the causes, diagnosis and management of this complex condition and relates specifically to chronic oedema of the lower limbs. We address the challenges nurses face in trying to manage the symptoms of chronic oedema/ lymphoedema and the trainer offers practical skills that will support nurses out in practice. You will be given the opportunity to develop full leg chronic oedema bandaging skills.

(Maximum of 30 places per session)

Tissue viability skills day

Nurses will have the opportunity to rotate round a number of work stations that will offer practical advice and support on how to develop specific skills. These may include a variety of the following:

  • Wound assessment/ leg ulcer assessment
  • Assessing wound bed tissue
  • Pressure ulcer risk assessment
  • Setting up pressure relieving equipment
  • Wound measurement – tracing and calculating wound size
  • Wound dressing selection and tips for using dressings on difficult anatomical sites
  • Identifying local wound bed infection
  • Bandaging – applying K two and Actico
  • Bandaging the limb with chronic oedema– how to shape the limb properly
  • Measuring and applying compression hosiery – Hot tips for easy application!
  • VAC therapy
  • Doppler assessment

Information about the formulary will also be available and companies manufacturing the products that support formulary will be on site to advise clinicians on the correct use of their dressings. Clinicians are encouraged to visit the product exhibition.

(maximum places 100)

Hosiery workshop

Currently in Oxfordshire, approximately 40% of healed patients develop leg ulceration again and most are found not to be wearing compression hosiery at the time despite it being the gold standard treatment for preventing recurrence. In addition to this, many people are at risk of developing leg ulceration due to underlying venous disease and leg oedema. This risk could be reduced if compression hosiery was worn.

Assessing and choosing hosiery doesn’t have to be the minefield that many clinicians think it is…

Join us at one of our informative and interactive workshops where you will learn how to:

  • Carry out an assessment for hosiery
  • Select the most appropriate garment for your patient’s condition
  • Measure the limb correctly to ensure there is an accurate fit
  • Apply the hosiery correctly
  • Care for the hosiery correctly and be able to advise the patient on long term prevention management.

Workshops are four hours long. Please come prepared to participate in a practical session which will involve limb measurement and hosiery application on each other.

Tea/ Coffee will be provided. Please feel free to bring your lunch with you.

(Maximum of 30 places per session)

ROHO and Starlock training

Tissue Viability no longer runs training sessions for the setup of ROHO cushions. If you or your service require training in how to set up ROHO or Starlock cushions please contact the relevant company to arrange this within your cluster, locality or team.

For ROHO cushions contact the PERMOBIL representative:
Mark Amos
Customer Services: 01484 722 888

For Starlock cushions please contact the Helping Hands representative:
Mitch Preedy
Email: mpreedy@helpinghand.co.uk
Mob: 07774621073
Office: 01531 635678

TV Competencies


We have a playlist of training videos on wound assessment and management our the Trust YouTube channel.

Go to: Tissue Viability training playlist

Conditions and treatment

Assessment is the foundation of all clinical practice; without a robust holistic assessment it is difficult to achieve a clear management plan. This section provides information and tools to aid clinicians in clinical practice and to support them to develop clear and achievable management plans.

The following guidelines are available to assist clinicians:

Wound prevention, assessment & management

We advocate the use of TIME principles to provide a systematic approach to the assessment and management of wounds. TIME is based on assessment and intervention in four clinical areas with the aim of producing a well vascularised wound bed that facilitates the effectiveness of other therapeutic measures.

The objectives underpinning TIME are:

  • T  – Tissue – assess for and treat any non-viable or deficient tissue
  • I –   Infection or Inflammation – identify and treat
  • M–  Moisture Imbalance – restore balance
  • E –  Epidermal Margin  non advancing or undermined – identify and optimize wound edges

This framework should be used in addition to obtaining a complete and in-depth medical history and discussion with the patient (and relatives/NOK if appropriate). Regular assessment and review of wound surface area, depth and undermining are also crucial when formulating a management plan. Wound photography is an invaluable tool to monitor progress or deterioration in the wound. Wound photography and mapping are both also fantastic tools in encouraging active participation with patients and can provide a real boost to patient morale.

The following tools and documents are available to assist clinicians and can be found under the resources Tab:

  • Abbey pain scale progress sheetwound assessment toggle - new
  • AMBLE Tool – Assessment/management of bacterial loading in wounds
  • Calculating wound surface area/size reduction
  • Leg ulcer assessment form
  • Lower limb assessment form
  • Pain assessment and management leaflet
  • Pathway for the treatment of skin that is damaged and excoriated by moisture
  • Potassium Permanganate Procedure
  • Protocol for the use of Topical Steroids in Wound Care
  • Removal of foam dressings
  • Wound assessment and evaluation form
  • Wound healing pathway/risk tool
Skin Tears

Skin tears are acute, traumatic wounds caused by the mechanical forces of shear, friction or trauma, including the removal of adhesives, resulting in a partial or complete separation of the outer skin layers from the inner tissue (ISTAP, 2018). They can occur anywhere on the body but are most commonly seen on the hands, arms and lower legs. 70–80% of skin tears occur on hands or arms. Skin tears can be painful and distressing for the patient.

It is estimated that prevalence of skin tears may be underreported and in fact be greater than pressure ulcers. To date, no prevalence data is available for the UK, so the cost to patients and the NHS is not fully known. The ageing population means that incidence of skin tears is increasing (elderly patients have fragile skin and are at increased risk)

Skin must be protected in at-risk patients and skin tears managed to avoid further damage and prevent progression from an acute to a more chronic, potentially hard to heal wound.

Management of Skin Tears in Residential Homes

The following resources are available to support Care Leaders in Residential Homes in providing 1st Aid to a skin tear:

Skin Tear Pathway V2 for Care Leaders in Residential Homes

Skin Tear Pathway V2 Training Presentation – Care Leaders in Residential Homes

Skin Tear Pathway Competency Checklist for Care Leaders in Residential Homes

Oxfordshire Wound Management Formulary

formulary pic

It is important that within the NHS we are able to justify our clinical decisions and expenditure on wound management products. In Oxfordshire we currently spend £1.8 million annually on dressings, bandages and tapes; therefore the wound management formulary has been developed with the explicit aims of:

  • Promoting evidence based practice by providing a framework within which it is safe to practice
  • Promoting continuity of care
  • Promoting rational prescribing
  • Encouraging safe, effective and appropriate use of dressings
  • Promoting cost effectiveness

Product selection should be based upon a comprehensive and holistic assessment of the patient and their wound. Once the wound aetiology and the intended treatment outcome have been confirmed, an appropriate product can be selected. If a patients wound fails to progress as expected then a referral to tissue viability should be considered.

VAC therapy

Negative Pressure Wound Therapy (NPWT) is the use of controlled suction to promote healing. ‘VAC’ is often used generically to denote NPWT, and means ‘Vacuum assisted closure.’ NPWT is helpful for promoting healing in circumstances where tissue perfusion is compromised, and also in some cases where excessive exudate cannot be controlled by other means.

NPWT involves applying a suction force (i.e. vacuum) across a sealed wound, using a reticulated foam interface or specified types of gauze.  Both the suction effect and the mechanical forces generated at the interface with the wound lead to a variety of changes in the wound, positively influencing the healing process.

Please follow the links below for further information and guidance.

Wound Infection and Biofilm

Pressure ulcers are caused when an area of skin and the tissues below are damaged as a result of being placed under pressure sufficient to impair its blood supply. The European Pressure Ulcer Advisory Panel defines them as:

“An area of localised damage to the skin and underlying tissue caused by pressure, shear, friction and/or a combination of these.” (EPUAP, 1999)

Typically they occur in a person confined to bed or a chair by an illness and as a result they are sometimes referred to as ‘bedsores’, or ‘pressure sores’. All patients are potentially at risk of developing a pressure ulcer. However, they are more likely to in people who are seriously ill, have a neurological condition, impaired mobility, impaired nutrition, or poor posture or a deformity (NICE, 2014).

Prevention and management

Pressure ulcers present a major health care challenge.   It has been recognized that pressure ulcers place a huge financial burden on the health care system and additionally result in a poor quality of life for the patient with an increased risk of morbidity.  It is also known that many pressure ulcers are avoidable.

Efforts to reduce occurrence of pressure ulcers need to focus on prevention rather than cure.  If we are to manage rates of pressure ulceration best practice needs to be employed by the use of guidelines, educational support and provision of appropriate equipment.

Braden tool

Nice guidance (2104) recommends using a validated scale to support clinical judgement when assessing pressure ulcer risk. Oxford Health has adopted the Braden tool as its pressure ulcer risk tool as it proven to provide higher inter-rater reliability and consistency of patient risk assessment.

An assessment of pressure ulcer risk for adults being admitted to secondary care or care homes in which NHS care is provided or receiving NHS care in other settings (such as primary and community care and emergency departments) should be undertaken on admission, or on the 1st visit in the community setting (NICE, 2014)


The following documents are available to clinicians to assist in pressure ulcer prevention and management:

Other documents found elsewhere on this site that may be useful include:

  • Oxford Health Pressure Area Care Leaflet
  • Oxfordshire Community Pressure Relieving Equipment Leaflet
  • Pressure ulcer management competency
  • Pressure damage prevention competency
  • Role of dietary factors in TV and wound Healing
  • Small appetite leaflet
  • Skin Inspection – Guidance & Form
  • SCALE Guidance
  • SCALE Final Consensus Statement 2009

leg ulcerA leg ulcer is defined as ‘the loss of skin from the knee to the ankle, which takes more than 6 weeks to heal’. There are several reasons why people get leg ulcers, the most common one (approx. 60 – 80%) being due to venous insufficiency arising from faulty valves in the veins and/ or poor calf muscle pump action. A smaller percentage of ulcers (10 – 20%) are caused by poor circulation in the arteries or as a result of other diseases such as diabetes or rheumatoid arthritis.

It is estimated that approximately 1% of the population in the United Kingdom will suffer from leg ulceration at some point in their lives with the experience often impacting negatively on their quality of life. Without correct treatment, ulcers can remain unhealed for many months or sometimes years, resulting in episodes of infection, pain and immobility.

To improve the healing rates of venous leg ulcers in Oxfordshire a venous leg ulcer treatment pathway has been introduced (click on venous leg ulcer pathway tab) which supports evidence based practice and has contributed to more ulcers being healed within 24 weeks. All clinicians delivering leg ulcer care are expected to use this pathway.

The resources found within this site will assist nurses with their clinical decision making when managing a patient with a leg ulcer.

Please see the following guidelines for further information:

Chronic Oedema Pathway

14 Chronic oedema

Chronic oedema is an umbrella term for swelling that does not respond to elevation or diuretics and which has been present for three months or more. It can occur in the limbs and/or the trunk, head and neck or genitalia. There are a number of possible causes including;

  • Dependency’ oedema: associated with immobility
  • Venous oedema: e.g. resulting from venous disease such

as post-thrombotic syndrome or severe varicose veins

  • Oedema associated with obesity
  • Lymphoedema: primary and secondary
  • Oedema related to advanced cancer
  • Oedema due to heart failure

Left untreated chronic oedema of the lower limbs can progress and cause skin changes such as discolouration, eczema, dry skin plaques and hardening of the tissues. The risk of developing leg ulcers increases as the tissues become more vulnerable to injury and wounds fail to heal properly. The tissues become prone to infection and can require hospital admission. In the advanced stages the limbs change shape developing skin folds with hard cobblestone skin. They can begin to leak fluid profusely as the skin is unable to contain the fluid.

Chronic oedema can have a significant impact on a person’s quality of life. It is also costly to the health service in terms of time, resources and staffing. The key to managing chronic oedema is early intervention to prevent disease progression. The main interventions include compression therapy, skin care, exercise and elevation. Managing chronic oedema complicated with ulceration, lymphorrhoea (leaky legs) or infection can prove a challenge. However, with appropriate management strategies, these factors can be reduced.

Compression therapy
Actico + Rosidal app5_2014

Correctly applied compression therapy is recognised as the mainstay of treatment for both the preventative and therapeutic care of venous disease, with high compression bandaging now established as the treatment of choice for venous leg ulceration. Compression therapy is mainly delivered through the application of bandaging or compression hosiery.

Compression therapy aims to reverse the effects of venous hypertension by:

  • Decreasing the capacity of and pressure within the superficial veins
  • Assisting venous return by increasing the blood flow velocity in the deep veins
  • Reducing oedema and subsequent wound exudate levels
  • Minimising or reversing skin changes that impact on wound healing.

Compression therapy should not be applied before the arterial status of the limb has been established (Doppler test) and should be applied in line with local policy and guidelines.

Please refer to the following Hosiery Booklet and Hosiery Formulary for guidance on the selection and application of compression hosiery in Oxfordshire:

Lower Limb Wound Pathway 2023

Leg ulcers are wounds on the lower leg (below the knee) and above the malleolus that are slow to heal. It is estimated that approximately 1.5% of the adult population in the UK is affected by active leg and foot ulceration, which equates to 730,000 patients. There is considerable variation in practice and outcomes which increases care costs and extends healing times. The biggest proportion of leg ulceration is due to venous insufficiency. However, many ulcers do have a mixed aetiology with either an element of arterial disease or be purely arterial. This revised guidance brings the care pathways for the various aetiologies together into one simplified document which we hope clinicians will find more accessible.

We have developed and made available a range of documents and guidelines to assist and inform clinicians within Oxfordshire.

Blank documentation
Guidelines and useful literature
Training presentations

Below are links to a selection of power point presentations form the various study days we run. Although we try and keep them as up to date as possible we do tend to make regular changes base on feedback we receive. You may find parts of the presentation differ slightly from the one you received but it shouldn’t be by much.

Wound Assessment and Management

Fundamentals of leg ulcer management

Chronic Oedema

Pressure Damage Prevention and Management 

Hosiery workshop

Useful websites

The following websites contain a wealth of resource for clinicians to access.

  • Activa Healthcare – For videos on full leg bandaging, measuring for hosiery and e-learning modules.


  • The British Lymphology Society – For guidance and resources on Lymphoedema.


  • The European Pressure Ulcer Advice Panel EPUAP

For International guidelines, conferences and pressure ulcer resources.


  • European Wound Management AssociationEWMA

For research and educational resources.


  • Wounds UK – For best practice statements, journal articles, ‘Made Easy’ booklets and many more useful resources.


  • Wounds International – For articles & webcasts raising awareness and sharing best practice world-wide.


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Page last reviewed: 21 November, 2023