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General plastic surgery

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


  • Airway compromise
  • Uncontrolled bleeding
  • Acute burns
  • Uncontrolled sepsis including hand infections
  • Complex facial fractures
  • Compound fractures
  • Threat to limb viability
  • Hand fractures (open or closed)
  • Acute fingertip injuries
  • Tendon injuries
  • Acute development of peripheral nerve compression symptoms following trauma or acute event
  • Lacerations and wounds not suitable for primary health management e.g. lip lacerations, large facial lacerations, lacerations with altered sensation, large skin defects.

Paediatric

  • Amniotic band compromising circulation

 

 

  • Refer to Healthpathways or local guidelines
  • Facial reanimation is generally a category 3 procedure, except when there is a threat to vision from lack of corneal protection.  The tarsorraphy / gold weight procedure may then become a category 1.
  • For eyelid laxity: 
    • Formal reduction in visual fields as measured by an optometrist 
    • Patients should have seen an optometrist within 12 months to exclude pressure problems, dry eye and other contraindications.
    • Patients would not usually be seen before 55 years of age

 

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Facial palsy with a threat to vision from lack of corneal protection
    • Acute facial palsy as a result of traumatic or surgical division of facial nerve
  • Category 2
    (appointment within 90 calendar days)
    • Ulcers with acute deterioration (e.g. sacral, ischial or lower limb)
    • Dermatochalasis of the eyelid
  • Category 3
    (appointment within 365 calendar days)
    • Abdominal wall defects e.g. gross divarication or hygiene issues where medical treatment has failed to resolve skin conditions arising under redundant skin (photograph required)
    • Chronic facial palsy without threat to vision
    • Symptomatic ptosis not involving visual axis
    • Blepharochalasia which obstructs the visual axis and > 55 years age

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History of anticoagulant therapy
  • Ptosis - BCVA (vision with most recent distance spectacles)
  • Blepharochalasia – Ophthalmologist or optometrist report including measure and impact of symptoms
  • Height, weight and BMI
  • Smoking status

 

3. Additional referral information Useful for processing the referral

  • Ptosis - Ophthalmologist or optometrist report including VA, refraction and impact of symptoms
  • Photograph – with patient’s consent, where secure image transfer, identification and storage is possible

 

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
  • Please note that where appropriate and available, the referral may be streamed to an associated public allied health and/or nursing service. This may include initial assessment and management by associated public allied health and/or nursing, which may either expedite or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.