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REFERRAL RECOMMENDATIONS PAEDIATRIC SURGERY

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REFERRAL RECOMMENDATIONS  PAEDIATRIC SURGERY Powered By Docstoc
					REFREC020


                         PLASTIC AND RECONSTRUCTIVE SURGERY REFERRAL RECOMMENDATIONS

      Diagnosis / Symptomatology                Evaluation                         Management Options                        Referral Guidelines
General problems include:          A thorough history and examination is   Specific treatments depend on specific   These guidelines are provided (below)
                                   required to determine a specific        problems identified as noted below.      to give greater clarity in situations of
     Acquired Deformities         diagnosis and its degree of urgency.                                             the primary/secondary interface of
     Congenital Deformities       Some appropriate investigation by the                                            care. Clear telephone/fax
     Degenerative Problems        referrer will facilitate the referral                                            communication would enhance
     Miscellaneous Problems       process.                                                                         appropriate treatment.
     Traumatic Problems                                                                                            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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    Diagnosis / Symptomatology                        Evaluation                     Management Options            Referral Guidelines
Acquired Deformities
Neoplasms –                                                                   Consider excision.          Cross refer Dermatology referral
                                                                                                          recommendations. Refer to Plastic
Benign Tumours of Skin
                                                                                                          Surgery only if diagnostically unclear
                                                                                                          or if causing compression symptoms –
                                                                                                          Category 4.
Salivary Gland – Minor or Major         Clinical evaluation including nerve                               Refer Plastic Surgery, ENT–
Glands                                  involvement.                                                      Category 3.
                                        Consider FNA and ultrasound (a
                                        negative FNA does not exclude
                                        malignancy) and CT scan.
Lipoma/Sebacous Cysts                                                                                     Refer if physical symptoms or
                                                                                                          diagnosis uncertain. Asymptomatic
                                                                                                          lipomas should not normally be
                                                                                                          referred.
Neoplasms – Suspected Malignant         Cross refer: Dermatology              Cross refer: Dermatology    Cross refer: Dermatology
Neoplasms of Skin                       Recommendations.                      Recommendations.            Recommendations.


                                        Note: Fremantle Hospital & Health
                                        Service Melanoma guidelines.
Suspected Malignant Neoplasms of the                                                                      Immediate referral to appropriate
Face, Oral Cavity, Para Nasal Sinuses                                                                     available specialty (eg, Plastic
and Neck                                                                                                  Surgery, Oral Maxillofacial, Head and
                                                                                                          Neck Clinic, ENT) – Category 1.
                                                                                                          Combined clinics available at
                                                                                                          Fremantle for these patients.




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    Diagnosis / Symptomatology                      Evaluation                   Management Options                         Referral Guidelines
    Congenital Deformities
Cleft Lip/Palate                      Antenatal ultrasound.              If antenatal ultrasound appearance of
                                      Family history.                    cleft lip/palate, seek advice from
                                                                         Plastic Surgical team.

                                                                                                                   Refer immediately to PMH – Category
                                                                         The Plastic Surgical team is able to      1. In the case of peralveolar cleft
                                      Appearance at birth.
                                                                         give specific advice related to feeding   palate, these children must be seen in
                                                                         difficulties or weight loss.              their first week of life.
Craniofacial Abnormalities            Skull facial bone and mandible                                               Referral of children to Paediatricians
                                      deformities.                                                                 for onward referral to PMH Craniofacial
                                      Family history.                                                              Service – Category 3. For adults, refer
                                                                                                                   direct to RPH Craniofacial Service –
                                                                                                                   Category 4.
External Ear Deformities              Check the presence of associated   Reconstruction.                                Children with external ear
                                      facial deformities.                Prosthesis                                      deformities should be referred at
                                                                                                                         around 4 years of age to the
                                                                                                                         Plastic Surgical Service –
                                      Family history.                    External ear surgery is unlikely to be          Category 4.
                                                                         done prior to the age of 6.
                                                                                                                        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.
                                      Check patient hearing status.
                                                                                                                   Refer for hearing abnormality to ENT
                                                                                                                   as required.
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,   Clinical suspicion.                Treat infection.                          Refer all patients for confirmation and
Congenital Dermoids, Cystic                                                                                        treatment – Category 4.
Hygromas, Thyroglossal Cysts and
Sinuses

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Torticollis                           Clinical evaluation.                                                            Refer to Plastic Surgery – Category 4.
Congenital Upper Limb and Chest       Clinical evaluation and early referral.                                         Early referral (neonatal) to Plastic
Abnormalities, including:                                                                                             Surgery – Category 3.
      Polands Syndrome
      Pectus Deformities
      Ring Constrictures
      Syndactyly
      All other hand deformities
Lower Limb, including:                As for upper limb.                        In suspicion of lymphoedema, do not   As for upper limb.
                                                                                order a lymphangiogram.
      Ring Constricture
      Syndactyly
      Lymphoedema
Trunk Abnormalities. These include:                                                                                   Refer to Paediatric Surgeons –
      Exomphalos                                                                                                     Category 2.
      Spina Bifida
General Abnormalities, including:     Refer on diagnosis.                                                             Hypospadias should be referred early
      Hypospadias                                                                                                    for treatment to be completed by
                                                                                                                      school age – Category 3.
      Vaginal Atresia
Vascular Malformations – including                                              Early assessment and advice on        Refer for complications, eg ocular
Lymphangiomas (as they are often                                                treatment course.                     lesions obstructing vision, rapid
mixed)                                                                                                                growth, ulceration – Category 3.




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    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                                  Refer as required for hand surgery
                                                       Splintage                                  (Orthopaedics).
                                                       Release
Osteoarthritis                                                                                    Refer as required for hand surgery
                                                                                                  (Orthopaedics).




    Diagnosis / Symptomatology            Evaluation           Management Options                          Referral Guidelines
Miscellaneous
Hyperhydrosis                                          Conservative at first by Dermatologists.   Refer as to whether endoscopic
                                                                                                  sympathectomy is appropriate –
                                                                                                  Category 4.
Pilonidal Sinus                                                                                   Refer to General Surgeons in the first
                                                                                                  instance – Category 4.




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    Diagnosis / Symptomatology                Evaluation                    Management Options                          Referral Guidelines
Traumatic
Post Surgery/Post Trauma/Post    This can be head and neck, hand.                                              Evaluation by original department of
Radiation Reconstruction                                                                                       surgery as required. Referral onward
                                                                                                               to Plastic Surgery as indicated.


Post Traumatic Scarring                                                                                        Plastic Surgical referral – Category 4.
Burns Scarring
Breast Reconstruction

Decubitus Ulcers                                                                                               Refer to Emergency Medicine.
Acute Inflammatory               See Dermatology Referral           See Dermatology Referral                   See Dermatology Referral
                                 Recommendations.                   Recommendations.                           Recommendations.
Chronic Inflammatory             Eg, Suppurative hydradenitis.      Long term antibiotics, dermatological      Refer if severity of disease and failed
                                                                    advice, control of diabetes, if present.   medical treatment justifies excision –
                                                                                                               Category 4.
                                                                                                               Refer to Rheumatologists as required
                                 Rheumatoid Arthritis.                                                         for hand surgery (Orthopaedics) –
                                                                                                               Category 4.




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