Plastic Surgery Trauma Clinic


Referral procedure

  • Only patients with a PSTC appointment and completed referral form will be reviewed at the PSTC.
  • All referrals must be discussed with and accepted by the Plastic Surgery Doctor on call. Contact via switch CUH (021 4922000).
  • Please consult the Plastic Surgery referral guidelines for a list of appropriate referrals.
  • Appropriate referrals not requiring hospital admission will be given an appointment for the Plastic Surgery Trauma Clinic at CUH (usually the following day).

Appropriate referrals

Facial Trauma

  • Complex wounds with skin loss
  • Possible involvement of facial nerve or parotid duct
  • Significant wounds involving the lip vermilion
  • Isolated fracture nasal bones

Upper limb Trauma

  • Replantation/Revascularisation of finger/hand
  • Compartment syndrome without bony injury
  • High-pressure injection injury of the fingers/hand
  • Complex wound with skin loss
  • Isolated large haematoma without bony injury
  • Any upper limb nerve injury
  • Tendon injury of forearm or hand
  • Ligamentous injury of digits
  • Complex fingertip injuries e.g. bone exposed
  • Open fractures/dislocations of digits/metacarpals

Lower limb trauma

  • Below knee amputation (excl. individual toes)
  • Complex wounds involving skin loss
  • Isolated large haematoma without bony injury
  • Possible associated major nerve injuries i.e. not digital nerve injuries (except big toe)
  • Paediatric lower limb wounds requiring GA

Cellulitis

  • Of the face / upper limb

Abscess/encrotising fasciitis

  • Abscess of Face, Upper Limb
  • Necrotising Fasciitis of Face, Upper or Lower Limb

Foreign bodies

  • Face and upper limb (when readily palpable)

Burn trauma

Inappropriate referrals

Facial trauma

  • Simple skin wounds not involving lip vermilion - EM
  • Eyelid injury +/- globe or tear duct injury – Ophthalmology
  • Isolated scalp wounds not involving tissue loss – EM
  • Fractured facial bones (exc. Isolated nasal bones) – MaxFax
  • Intra-oral trauma – MaxFax

Upper limb trauma

  • Simple superficial skin wounds - EM
  • Simple fingertip injuries – EM
  • Isolated vascular injury - Vascular
  • Closed fractures of the hand – Ortho
  • Wrist, forearm & arm dislocations/# - Ortho
  • Compartment syndrome with bony injury - Ortho

Neck trauma

  • Penetrating neck wounds - Gen Surg (±- Vasc./ENT)
  • Simple superficial skin wounds – EM

Lower limb trauma

  • Compartment syndrome - Ortho
  • Isolated vascular injury – Vascular
  • Wounds over anterior knee or achilles tendon - Ortho
  • Non-complex wounds – EM
  • Tendon injury - Ortho
  • Toes: Nailbed / digital nerve injury (except hallux) – EM
  • Amputated toes - Ortho

Cellulitis

  • Cellulitis elsewhere - EM or ID

Abscess/Necrotising fasciitis

  • Abscess of Trunk/Perineum/Lower Limb - Gen Surg
  • Abscess of Breast - Breast Surgery
  • Abscess Intra-oral/dental - Max Fax
  • Nec Fasc of Trunk and Perineum - Gen Surg
  • Fournier’s Gangrene - Urology

Foreign bodies

  • Impalpable foreign bodies - EM
  • Palpable Foreign bodies:
    • Lower Limb - Ortho
    • Neck/Trunk (excluding breast)/Perineum - Gen Surg
    • Breast - Breast Surgery

Others

*Infections: The Reconstructive Plastic Surgery Department is not a generalised debridement service. We provide a reconstruction service. We are happy to consult on complex wounds or to provide assistance with debridement where required.

Wound advice: CUH employs wound care nurse specialists to review inpatient wounds & will advise with the plastic surgery service.

Pressure sores: Admit under medical team on call, who should then arrange review by the rehabilitation consultant, Dr McFarland ± ID, Plastic Surgery, Ortho, Gen Surg, Urology, Neurology, Occupational Therapy, Physiotherapy, Dietetics, Social Work.



Content by Dr Íomhar O' Sullivan 13/07/2016. Last review Dr Karol O'Donovan, Mr Michael O'Shaughnessy, Dr ÍOS 1/06/21.