REFREC020
PLASTIC AND RECONSTRUCTIVE SURGERY REFERRAL RECOMMENDATIONS
Diagnosis / Symptomatology
General problems include:
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Acquired Deformities
Congenital Deformities
Degenerative Problems
Miscellaneous Problems
Traumatic Problems
Last updated February 2006
Evaluation
A thorough history and examination is
required to determine a specific
diagnosis and its degree of urgency.
Some appropriate investigation by the
referrer will facilitate the referral
process.
Management Options
Referral Guidelines
Specific treatments depend on specific
problems identified as noted below.
These guidelines are provided (below)
to give greater clarity in situations of
the primary/secondary interface of
care. Clear telephone/fax
communication would enhance
appropriate treatment.
It should be noted that the public
health provider responsibility does not
rest with the alteration of what is
regarded within the general population
as the normal appearance or function,
i.e. cosmetic.
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REFREC020
Diagnosis / Symptomatology
Evaluation
Management Options
Referral Guidelines
Acquired Deformities
Neoplasms –
Consider excision.
Benign Tumours of Skin
Salivary Gland – Minor or Major
Glands
Clinical evaluation including nerve
involvement.
Consider FNA and ultrasound (a
negative FNA does not exclude
malignancy) and CT scan.
Refer Plastic Surgery, ENT–
Category 3.
Lipoma/Sebacous Cysts
Neoplasms – Suspected Malignant
Neoplasms of Skin
Cross refer Dermatology referral
recommendations. Refer to Plastic
Surgery only if diagnostically unclear
or if causing compression symptoms –
Category 4.
Refer if physical symptoms or
diagnosis uncertain. Asymptomatic
lipomas should not normally be
referred.
Cross refer: Dermatology
Recommendations.
Cross refer: Dermatology
Recommendations.
Cross refer: Dermatology
Recommendations.
Note: Fremantle Hospital & Health
Service Melanoma guidelines.
Suspected Malignant Neoplasms of the
Face, Oral Cavity, Para Nasal Sinuses
and Neck
Last updated February 2006
Immediate referral to appropriate
available specialty (eg, Plastic
Surgery, Oral Maxillofacial, Head and
Neck Clinic, ENT) – Category 1.
Combined clinics available at
Fremantle for these patients.
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REFREC020
Diagnosis / Symptomatology
Evaluation
Management Options
Referral Guidelines
Congenital Deformities
Cleft Lip/Palate
Antenatal ultrasound.
Family history.
Appearance at birth.
If antenatal ultrasound appearance of
cleft lip/palate, seek advice from
Plastic Surgical team.
The Plastic Surgical team is able to
give specific advice related to feeding
difficulties or weight loss.
Craniofacial Abnormalities
Skull facial bone and mandible
deformities.
Family history.
External Ear Deformities
Check the presence of associated
facial deformities.
Reconstruction.
Prosthesis
Family history.
External ear surgery is unlikely to be
done prior to the age of 6.
Refer immediately to PMH – Category
1. In the case of peralveolar cleft
palate, these children must be seen in
their first week of life.
Referral of children to Paediatricians
for onward referral to PMH Craniofacial
Service – Category 3. For adults, refer
direct to RPH Craniofacial Service –
Category 4.
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Children with external ear
deformities should be referred at
around 4 years of age to the
Plastic Surgical Service –
Category 4.
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Children with associated facial
abnormality should be referred
before the age of 2 – category 4
In most circumstances, adults with
prominent ears will not be treated.
Refer for hearing abnormality to ENT
as required.
Check patient hearing status.
Nose Deformities
Children refer Craniofacial guidelines.
Adults are unlikely to be treated unless
very severe.
Orbit and Eyelid Deformities
Refer as Craniofacial guidelines.
Branchial Cysts, Branchial Sinuses,
Congenital Dermoids, Cystic
Hygromas, Thyroglossal Cysts and
Sinuses
Last updated February 2006
Clinical suspicion.
Treat infection.
Refer all patients for confirmation and
treatment – Category 4.
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REFREC020
Torticollis
Clinical evaluation.
Refer to Plastic Surgery – Category 4.
Congenital Upper Limb and Chest
Abnormalities, including:
Clinical evaluation and early referral.
Early referral (neonatal) to Plastic
Surgery – Category 3.
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Polands Syndrome
Pectus Deformities
Ring Constrictures
Syndactyly
All other hand deformities
Lower Limb, including:
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Ring Constricture
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Syndactyly
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Lymphoedema
As for upper limb.
In suspicion of lymphoedema, do not
order a lymphangiogram.
Refer to Paediatric Surgeons –
Category 2.
Trunk Abnormalities. These include:
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Exomphalos
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Spina Bifida
General Abnormalities, including:
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Hypospadias
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Vaginal Atresia
Vascular Malformations – including
Lymphangiomas (as they are often
mixed)
Last updated February 2006
As for upper limb.
Refer on diagnosis.
Hypospadias should be referred early
for treatment to be completed by
school age – Category 3.
Early assessment and advice on
treatment course.
Refer for complications, eg ocular
lesions obstructing vision, rapid
growth, ulceration – Category 3.
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REFREC020
Diagnosis / Symptomatology
Evaluation
Management Options
Referral Guidelines
Degenerative
Ectropion
Refer to Ophthalmology Referral
Recommendations – Category 4.
Dupuytrens Contracture
Refer for surgery for symptoms or
flexion of the PIP or MCP joint –
Category 4.
Carpal Tunnel Compression
E.M.G.
Injection
Splintage
Release
Osteoarthritis
Diagnosis / Symptomatology
Refer as required for hand surgery
(Orthopaedics).
Refer as required for hand surgery
(Orthopaedics).
Evaluation
Management Options
Referral Guidelines
Miscellaneous
Hyperhydrosis
Pilonidal Sinus
Last updated February 2006
Conservative at first by Dermatologists.
Refer as to whether endoscopic
sympathectomy is appropriate –
Category 4.
Refer to General Surgeons in the first
instance – Category 4.
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REFREC020
Diagnosis / Symptomatology
Evaluation
Management Options
Referral Guidelines
Traumatic
Post Surgery/Post Trauma/Post
Radiation Reconstruction
This can be head and neck, hand.
Evaluation by original department of
surgery as required. Referral onward
to Plastic Surgery as indicated.
Post Traumatic Scarring
Burns Scarring
Breast Reconstruction
Plastic Surgical referral – Category 4.
Decubitus Ulcers
Refer to Emergency Medicine.
Acute Inflammatory
See Dermatology Referral
Recommendations.
See Dermatology Referral
Recommendations.
See Dermatology Referral
Recommendations.
Chronic Inflammatory
Eg, Suppurative hydradenitis.
Long term antibiotics, dermatological
advice, control of diabetes, if present.
Refer if severity of disease and failed
medical treatment justifies excision –
Category 4.
Rheumatoid Arthritis.
Last updated February 2006
Refer to Rheumatologists as required
for hand surgery (Orthopaedics) –
Category 4.
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