Editors

HannuKuokkanen

Injuries Requiring Plastic Surgery

Laceration injuries of the face, such as in windscreen injury, require primary plastic surgery. Debridement is carried out first, followed by meticulous closure.
- NB: “Road rash” injury must be brushed clean immediately after the injury using local/general anaesthesia.
Injuries of the facial bones should be treated by maxillofacial surgeons.
Skin and soft tissue injuries in the face, such as a dog bite Bite Wounds, should be treated immediately by a plastic surgeon carrying out careful revision and immediate reconstruction.
Shotgun injuries to the face should be treated primarily by a plastic surgeon together with a team comprising a neurosurgeon and a maxillofacial surgeon. Careful revision should be made. Reconstruction is carried out on emergency basis. In most cases free microvascular flaps are used. Shotgun injuries usually need multiple reconstructions.

See Replantation of an Amputated Extremity or Body Part
Hand surgeons perform replantations of the upper limb region and plastic surgeons replantations of the lower limb and other organs.
The following parts of the body can be replanted:
- finger or fingers, hand, hand amputated at the wrist, upper extremity
- lower extremity or part of it
- ear, scalp, nose, lip
- penis
If any part of the body named above has been amputated, the patient is given first aid and a careful clinical examination is performed. The nearest hospital with readiness for replantation surgery is contacted by telephone as soon as possible. It is usually possible to assess already in the phone whether replantation is indicated.

Severe injuries of the lower extremities must be referred to trauma centres that have the possibility to provide a multiprofessional assessment and treatment. A specialist in traumatology together with a plastic surgeon assess the treatment possibilities and lines of action immediately in the initial phase.
Revision of dead tissue and fasciotomies are performed primarily. The fracture is stabilized with either external or internal fixation . Blood circulation is repaired in cooperation with a vascular surgeon.
In the treatment of a severely injured patient, a gradual approach is applied using the damage control principle.
If necessary, soft tissue reconstruction and possible bone grafting are performed either immediately or after a few days. Microsurgical tissue grafts are often required.
Muscle ruptures may exist in the truncal region (safety belt injury), requiring corrective surgery in the subacute phase.

If the tissue damage is caused by a high-energy injury, the patient should be sent early to a multi-professional trauma centre. Dead tissue and parts with deficient blood circulation are removed, and the tissue defects are repaired either immediately or with a few days' delay.
Skin detached from its circulation or remaining parts of a limb may be used as tissue grafts to cover the injured area.

Small first and second degree superficial burns may be treated within the primary health care Burn Injuries. Deep burns of second and third degree should be referred to an evaluation by a plastic surgeon.
The treatment of severe burns (e.g. ones requiring fluid therapy and injuries of the hands, face and genitals) may be centralized to one or few centres in the country or region.
Severe frostbites that endanger the vitality of the fingers, toes and limbs are in some cases treated by thrombolytic therapy Frostbite Injuries. Patients should be referred urgently for an evaluation.
Injuries caused by acids and bases should be rinsed with plenty of fluids and the patient should be referred urgently for an evaluation by a plastic surgeon.
Extravasations caused by cytotoxic drugs and contrast media may be treated by internal lavage of the tissue. In severe cases the patient should be referred urgently for an evaluation by a plastic or hand surgeon.