PLASTICS Referral Guidelines
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1 PLASTICS 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. Routine: 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. 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 Phone Specialist Clinics Plastics / ENT Liaison Nurse to ensure referral is received Advise patient to attend Emergency Department Immobilise hand X-ray of affected hand Send results with referral Patient to bring X Ray films to Outpatient clinic at time of appointment Instruct patient to bring films & diagnostic results to the Specialist Clinic appointment. or conservative management Acute finger Tip Injuries Refer patient immediately to the ED X-ray /no surgery 2
2 Nerve Palsies Nerve conduction tests Acute- urgent 3 Non acute- Non urgent 2 Dupytren s Contracture Non urgent /no surgery 2 Stenosing tenosynovitis (De Quervain s/trigger finger) Include details of functional impairment in referral Non urgent /no surgery 1-2 Soft Tissue Tumours of the Hand (i.e. ganglia) Include details of functional impairment in referral Ultrasound of affected hand Non urgent /no surgery 1-2 Rheumatoid Hand Deformities - Results from Rheumatology appointment to be sent with referral -Patient to bring x- rays to appointment X-ray of affected hand Rheumatology review Details of functional impairment /no surgery Secondary Hand after injury Include functional X-ray of affected hand Non urgent /no surgery Carpel Tunnel & Other Nerve Compression Syndromes Nerve conduction studies completed and enclosed in referral /no surgery 2
3 GENERAL Burns Assess severity of burn. - full or partial thickness burns refer to Emergency Department - 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 /no surgery 4 Burn Scar management Non - depending on severity of scar site and presence of functional impairment 1 Pressure Sores Prior to referral Contact Plastics/ ENT Specialist Clinics Liaison Nurse to assess treatment of non-ambulant patient ph depending on severity, size, site and if VAC Dressing in situ Non if Chronic Other Chronic sores and Ulcers Prior to referral Information on prior treatment, length of time sores/ulcers present, treatment already applied, pain, and site of ulcer/sore Non depending on severity 3 5
4 Foreign Body Removal Enclose test results with referral X-ray or ultrasound surgery 1-2 Lymphedema Refer to Mercy Hospital Lymphedema Clinic N/A Lymphedema Vascular Malformations Paediatric refer to RCH Ultrasound of lesion N/A Vascular Malformations BREAST Reconstruction(usually after mastectomy) Non urgent surgery 3 Augmentation Mammoplasty Non - Refer only if post mastectomy reconstruction, congenital/contralateral breast or post burn reconstruction surgery 3 Gynecomastia Non surgery 3 Congenital abnormalities Non surgery 3 NOSE Fractured Nose (traumatic/immediate) REFER TO ENT OR ED N/A
5 Nasal Reconstruction Refer to ENT X-rays nose/ face N/A Rhinophyma Non surgery EYELIDS Ectropian Non 2 Eyelid Reduction in abnormal cases Non - only seen if vision impaired surgery 2 EARS Ear Reconstruction (Congenital or Traumatic abnormalities) - post acute trauma Non - if congenital 2 2 LESIONS Melanoma -confirmed or suspected Include pathology and other investigations if available If confirmed can also be referred to Melanoma Clinic DO NOT perform punch biopsy if melanoma suspected NOTE- appointment is for assessment only, not for excision of lesion 2 Other Skin Cancers (not melanoma) confirmed or Suspected i.e. BCC or SCC If confirmed, send results with referral including size, colour, and site, +/- excision required. NOTE- appointment is for assessment only, not for excision of lesion 2
6 Subcutaneous and Deep Tissue Tumours USS of lesion +/- CT if malignancy suspected - if confirmed or suspected Non - if no malignancy Benign Skin Lesions Include colour, size site +/- excision required in referral If results available, also send with referral. Non NOTE- appointment is for assessment only, not for excision 2 Margins Not Clear Post Previous of Lesions Include in referral operation report date and notes, margins not cleared and pathology reports for malignancies Skin checks 3/12-2yrs
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