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