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Reconstructive hand 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
  • Splint and activity modification
  • Consider steroid injections as appropriate
  • Joint ROM exercises
  • Occupational therapy/physiotherapy to maintain mobility/ prevent stiffness and contracture/maintain extension/prevent/control pain/strengthening

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Severe/disabling symptoms of nerve compression and/or muscle weakness or wasting and NCS confirmation of diagnosis
    • Soft tissue tumour of the hand with suspicion of malignancy
  • Category 2
    (appointment within 90 calendar days)
    • Frequent symptoms of nerve compression and any of the following:
      • rapid progression
      • recurrence after surgical decompression
      • failed maximal medical management (refer to Healthpathways)
    • Major impacts on ADLs and/or employment
  • Category 3
    (appointment within 365 calendar days)
    • Secondary hand surgery after injury
    • Stenosing tenosynovitis and failed medical management
    • Rheumatoid hand deformity with impaired function or pain and failed maximal medical management
    • Symptomatic or enlarging ganglion of the hand

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 handedness, occupation, significant hobbies and anticoagulant therapy
  • Smoking status
  • Medical management to date (include Allied health input and steroid injections)
  • Detailed clinical examination with sensory mapping and functional assessment (include impacts on ADL and employment)
  • Comprehensive neurovascular assessment
  • Details of functional impairment
  • XR for confirmed or suspected fracture or rheumatoid hand deformity
  • NCS required for Cat 1 cases only
  • Hand USS for stenosising tenosynovitis and soft tissue tumours of the hand

3. Additional referral information Useful for processing the referral

  • Occupational therapy/physiotherapy report
  • Nerve conduction studies if referred for nerve compression syndromes or nerve palsies

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.