Plastic Surgery Consult 🩹
Guide for plastic surgery consultation and referral. Key information to provide, common indications, and referral scripts for NCHDs.
📋 Key Info to Have Ready
- Patient identifiers: full name, date of birth, location, and MRN
- Reason for consult: wound management, reconstruction, trauma, infection, or cosmetic concern
- Mechanism of injury (if trauma): time of injury, mechanism, contamination level
- Wound description: size, depth, location, tissue involvement, contamination, foreign bodies
- Vascular status: pulses, capillary refill, temperature, sensation distal to injury
- Functional status: range of motion, strength, any functional deficits
- Past Medical History: diabetes, vascular disease, smoking, previous surgeries, allergies
- Current medications: anticoagulants, immunosuppressants, antibiotics
- Vital signs: especially if signs of systemic infection or shock
- Relevant imaging: X-rays for foreign bodies, CT/MRI if deeper structures involved
- Photographs: clear, well-lit images of the area of concern
🔎 Investigations to Know
- Bloods: FBC, CRP, U&E, LFTs, coagulation profile
- Wound swabs: for culture and sensitivity if infection suspected
- Imaging: X-rays for foreign bodies, CT/MRI for complex injuries
- Vascular studies: if compromised circulation suspected
- Tissue viability assessment: clinical examination, possibly Doppler studies
📞 Example Script
- Hi, this is [Your Name], the intern from [Team Name]. I'm calling to request a plastic surgery consult for a [Age]-year-old [M/F] with a [type of injury/condition].
- The injury occurred [time] ago via [mechanism]. The wound is [size] and involves [tissues affected]. The area is [clean/contaminated] with [foreign bodies if present].
- Neurovascular status is [intact/compromised] with [describe pulses, sensation, movement].
- The patient has a background of [relevant PMH] and is currently on [relevant medications].
- Vital signs are stable, and bloods show [relevant results]. We're seeking your advice on [wound management/reconstruction/timing of intervention].
🩹 Common Plastic Surgery Referrals
- Hand injuries: lacerations, crush injuries, tendon/nerve damage
- Facial trauma: lacerations, fractures, soft tissue defects
- Burn injuries: assessment of depth, extent, and need for grafting
- Wound complications: dehiscence, infection, non-healing wounds
- Reconstruction: post-tumor excision, pressure sores, chronic wounds
- Cosmetic concerns: though often outpatient, may need urgent assessment
- Necrotising infections: Fournier's gangrene, necrotising fasciitis
⏰ Timing Considerations
- Hand injuries: ideally within 6-8 hours for optimal outcomes
- Facial lacerations: within 12-24 hours for best cosmetic results
- Burn injuries: immediate assessment for depth and extent
- Necrotising infections: immediate surgical consultation
- Clean wounds: can often wait for next available clinic
- Infected wounds: may need urgent debridement
📝 Tips
- Always assess and document neurovascular status thoroughly
- Take clear photographs before and after any intervention
- Consider tetanus status and need for prophylaxis
- Document wound measurements and characteristics precisely
- Mention any foreign bodies or contamination clearly
- For hand injuries, document specific nerve and tendon function
- Consider patient's occupation and hand dominance for hand injuries
- Ask about pain control and current analgesia
🚨 Red Flags - Call Immediately
- Compromised neurovascular status (pulseless, cold, numb)
- Necrotising soft tissue infection (rapidly spreading, severe pain)
- Compartment syndrome (pain out of proportion, tense compartments)
- Major tissue loss or amputation
- Penetrating injuries to vital structures
- Signs of systemic infection or sepsis