Paediatric plastics referral triage

NHS Tayside ED Guidance
NHS Tayside

*If in doubt, please discuss your case with the on call Plastics team.

This is a guide and does not encompass all possible scenarios.

  • 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 virtual clinic (V) or review in trauma clinic/ward (T):

  • Complications, e.g. localised infection, slow to heal (T)

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
  • Any doubt or concern regardless of size or area
  • Non accidental injury – please refer to NHS Tayside Child Protection Policy

Urgent referral to registrar:

  • Suspected airway involvement
  • Neurovascular compromise
  • Major burns (for initial management prior to transfer)
  • Burns requiring resuscitation (over 10% total body surface area) for initial management prior to transfer to Paediatric Burns Centre
  • High voltage electrical injuries
  • Sepsis

Cobis (2018) Guideline for the management of paediatric 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 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.

Facial injuries

Review in virtual clinic (V) or review in trauma clinic/ward (T):

  • Lacerations - unable to close in ED (T)

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

Hand injuries - bony

Review in virtual clinic (V) or review in trauma clinic/ward (T):

  • Undisplaced/no rotation, closed, stable fractures (V)

Discuss with on call team/H@N:

  • Displaced/rotational deformity
  • Unstable
  • Open
  • Non accidental injury

Urgent referral to registrar:

  • Vascular compromise, including tip amputations in children

Hand injuries - soft tissue

Discuss with on call team/H@N:

  • Wound associated with functional/sensory deficit
  • Foreign bodies
  • Gross contamination
  • Non accidental injury

Urgent referral to registrar:

  • Vascular compromise, including tip amputations in children

Extravasation injuries

Review in virtual clinic (V) or review in trauma clinic/ward (T):

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

Urgent referral to registrar:

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

Others

Urgent referral to registrar:

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