Adult plastics referral triage

NHS Tayside ED Guidance
NHS Tayside

This is a guide and does not encompass all possible scenarios. If in doubt, please discuss your case with the on call Plastics team.

For the emergency and virtual patient referral and booking process, please refer to the Standard Operating Protocol disseminated to ED, MIU and H@N.

  • H@N to call ext 32597 (Area 3A Nurses Station) at 8am (Mon to Fri) to leave name and details of any overnight admission.
  • Generic Plastics email for emergency and virtual clinic patient referrals: Tay-uhb.plasticsurgeryreferrals@nhs.net
  • Generic Plastics email for advice: Tay-uhb.plasticsurgeryoncall@nhs.net

Burns

Review in trauma clinic:

  • Complications, e.g. localised infection, slow to heal

Discuss with on call team/H@N:

  • Chemical burns except hydrofluoric acid
  • Electrical burns
  • Special areas – face, hands, feet, perineum, joints
  • Full circumferential
  • Full thickness
  • Vulnerable adult
  • Any doubt or concern regardless of size or area

Urgent referral to registrar:

  • Suspected airway involvement
  • Neurovascular compromise
  • Major burns (for initial management prior to transfer)
  • Burns requiring resuscitation (mor than 15% total body surface area)
  • High voltage electrical injuries

Cobis (2018) Guideline for the management of adult burns.

Infections

Discuss with on call team/H@N:

  • We do not accept referrals for debridement of infections unless
    • hand
    • involvement of upper limb neurovascular structures or
    • known plastics patient
  • Indications for referral for the above group of patients are:
    • abscess
    • septic
    • ascending lymphangitis or lymphadenopathy

Urgent referral to registrar:

  • Necrotising fasciitis
  • Management and debridement by appropriate surgical team. Our role is to support the surgical team and reconstruct the resultant defect.
  • Separate necrotising fasciitis protocol being developed

Facial injuries

Review in trauma clinic:

  • Lacerations - unable to close in ED

Discuss with on call team/H@N:

  • If suspected head injury – not for Plastics until cleared
  • Multiple/complex once fracture excluded

Urgent referral to registrar:

  • Polytrauma

Pretibial lacerations

Review in trauma clinic:

  • Complications, e.g. localised infection, slow to heal

Discuss with on call team/H@N:

  • If needs admitted due to falls or frailty, then under medical team or local hospital

Urgent referral to registrar:

  • Under truly exceptional circumstances

Haematomas

Review in trauma clinic:

  • Complications, e.g. localised infection, slow to heal

Discuss with on call team/H@N:

  • Large, non expanding
  • Large, known to Plastics
  • Infected, known to Plastics

Urgent referral to registrar:

  • Rapidly expanding, skin compromise
  • Rapidly expanding, coagulopathy/on anticoagulants – admit under medics

Extravasation injuries

Review in trauma clinic:

  • IV radiological contrast*
  • Non ionic*
  • over 24 hrs old, no skin necrosis*
  • Irritants/vesicants/iron (ionic) over 24 hrs old +/- skin compromise

Urgent referral to registrar:

  • Irritants/vesicants/iron under 24 hrs
  • Any substance with unknown properties under 24 hrs following discussion with the Poisons Centre

Other injuries

Urgent referral to registrar:

  • Polytrauma
  • Compartment syndrome
  • Significant crush and/or large degloving injury