Plastic Surgery Referral Guidelines

Transcription

1 Plastic Referral Guidelines Austin Health PLASTICS Unit holds fortnightly multidisciplinary meetings with ENT/ Maxillary Facial and Oncology Units to discuss and plan the treatment of patients with cancerous conditions. Two clinics operate weekly to incorporate new referrals. Department of Health clinical urgency categories for specialist clinics Referrals should be categorised as urgent if the patient has a condition that has the potential to deteriorate quickly, with significant consequences for health and quality of life, if not managed promptly. These patients should be seen within 30 days of referral receipt. For emergency cases please send the patient to the Emergency department. Semi Referrals should be categories as Semi Urgent that has the potential to deteriorate within days. Referrals should be categorised as routine if the patient s condition is unlikely to deteriorate quickly or have significant consequences for the person s health and quality of life if specialist assessment is delayed beyond one month. Exclusions: Abdominoplasty procedure and breast reductions not offered. Fractured Nose refer immediately to ED. Nasal Reconstruction refer to ENT Condition / Symptom GP Management Investigations Required Prior to Referral Expected Triage Outcome Expected Specialist Intervention Outcome Expected number of Specialist Appointments HANDS Open Hand fracture Closed Hand Fracture Fax referral details to Specialist Clinics Clinical history and examination X-ray of affected hand 1 week or conservative management 2-3 Phone Specialist Clinics Plastics / ENT Liaison Nurse to ensure referral is received Advise patient to attend Emergency Department Immobilise hand

2 Acute finger Tip Injuries Refer patient immediately to the ED X-ray of affected finger 1 week /no surgery 2 Nerve Palsies Post nerve conduction test Clinical history and examination Nerve conduction tests Acute Non acute No surgery 3 2 Dupytren s Contracture Clinical history and examination /no surgery 2 Stenosing Tenosynovitis (De Quervain s/trigger Include details of functional impairment in referral /no surgery 1-2 finger)

3 Soft Tissue Tumours of the Hand (i.e. ganglia): Include details of functional impairment in referral Clinical history and examination Ultrasound of affected hand /no surgery 1-2 Rheumatoid Hand Deformities: Rheumatology review with details of functional impairment Clinical history and examination Results from Rheumatology appointment to be sent with referral X-Ray of affected hand /no surgery 2-3 Secondary Hand after injury: Previous hand surgery Include functional /no surgery 2-3 X-Ray of affected hand

4 Carpel Tunnel & Other Nerve Compression Syndromes: Post Nerve conduction studies Diagnostics: Nerve conduction studies completed and enclosed in referral /no surgery 2 GENERAL Burns: Assess severity of burn. Full or partial thickness burns refer to ED Minor burns refer to plastics unit If burns greater than 10% or full thickness burns greater than 5% refer to Alfred Hospital Paediatric burns refer to RCH Document any treatment already carried out 1-2 weeks /no surgery 4 Burn Scar management: Post burn surgery Document any treatment already carried out Semi or Depending on severity of scar site and presence of functional impairment No surgery 2-3 1

5 Pressure Sores: When To Refer: Prior to referral Contact Plastics/ ENT Specialist Clinics Liaison Nurse to assess treatment of nonambulant patient ph depending on severity, size, site and if VAC Dressing in situ Chronic Pressure Sores No surgery Other Chronic sores and Ulcers: Post prior treatments Information on prior treatment, length of time sores/ulcers present, treatment already applied, pain, and site of ulcer/sore Semi or Depending on severity No surgery 3 5 Foreign Body Removal: Enclose test results with referral X-ray or ultrasound 1-2

6 Vascular Malformations: All paediatrics refer to RCH Ultrasound of lesion As required BREAST Reconstruction-usually after mastectomy: Post mastectomy 3 Augmentation Mammoplasty: Refer only if post mastectomy reconstruction, congenital/contralateral breast or post burn reconstruction 3 Gynecomastia: 3

7 Congenital abnormalities: surgery 3 NOSE Rhinophyma: 2-3 EYELIDS Ectropian: 2 Eyelid Reduction in abnormal cases only seen if vision impaired 2

8 EARS Ear Reconstruction: Congenital or Traumatic abnormalities Traumatic or congenital abnormalities Post-Acute Trauma If congenital 2 2 LESIONS Melanoma: Confirmed or suspected If confirmed can also be referred to Melanoma Clinic DO NOT perform punch biopsy if melanoma suspected Diagnostics: All Pathology Results 1-2 weeks NOTEappointment is for assessment only, not for excision of lesion 2 Other Skin Cancers: Confirmed or suspected i.e. BCC or SCC (Not Melanoma) Confirmed results size, colour, and site, +/- excision required. 1-2 weeks NOTEappointment is for assessment only, not for excision of lesion 2

9 Subcutaneous and Deep Tissue Tumours: If confirmed or suspected Imagining: U/S of lesion +/- CT if malignancy suspected If confirmed or suspected If no malignancy 2-3 Benign Skin Lesions: If confirmed or suspected Include colour, size site +/- excision required in referral Imagining: U/S of lesion Non NOTEappointment is for assessment only, not for excision 2 Margins Not Clear Post Previous of Lesions Post previous surgery with unclear margins operation report date and notes, margins not cleared Diagnostics: Pathology reports from operation For malignancies 2-3 Skin checks 3/12-2yrs