Plastic Surgery Emergencies

Dr. Shane KF Seal

CORE Lecture

August 27, 2008

What are some ‘true’ emergencies?

Topics

1. Necrotizing Fasciitis

2. Compartment Syndrome

3. Ischemic Limb / Amputated Part

4. Suppurative Flexor Tenosynovitis

5. Septic Joint

6. Major Burn

Necrotizing Fasciitis

• NF vs. NSTI

• Travels along fascial planes

• Types:– I– II– III

Necrotizing Fasciitis

• Appearance

• Presentation/CC

• Investigations (relevant)

Necrotizing Fasciitis

• Management– Surgical – Medical– Monitoring

• Long term plans

Compartment Syndrome

• Definition– Absolute vs. Relative

• Signs/Symptoms– Early vs. late– Most reliable sign– Most reliable symptom

Compartment Syndrome

• Investigations (relevant)

• ‘Whitesides’ technique

• Abdominal Compartment measurements

Compartment Syndrome

• Management– Know the anatomy!

• Closure options

• Late management

Ischemic Limb/Amputated Part

• Ischemic Limb– Why?– Acute vs. Chronic?

• Investigations

• Consults

Ischemic Limb/Amputated Part

• Traumatic ischemic limb– Management options

• Rheumatologic ischemic limb– Management options

• Medical• Surgical

Ischemic Limb/Amputated Part

• Amputation– Mechanism of injury– Timing– Level of injury

• Investigations

Ischemic Limb/Amputated Part

• To replant or not to replant????

– Issues that will affect decisions

Suppurative Flexor Tenosynovitis

• Closed system• Can spread quickly

along sheath

Suppurative Flexor Tenosynovitis

• Presentation

• Signs/Symptoms– Kanavel’s 4 Findings– Most reliable sign

• Management– Medical– Surgical

Septic Joint

• Mechanism– Animal/human bite

• Examination– Position of joint– Most reliable way to test– Other associated conditions

Septic Joint

• Investigations

• Management– Surgical – Medical

Major Burn

• Definition

• Criteria for admission to a Burn Unit

• Management– Fluids ‘Parkland’

• Assessing Depth

Major Burn

• Acute issues to deal with

• Consults

• Medical management• Topical Management• Surgical Management

– timing