1. Plastic Surgery Emergencies Dr. Shane KF Seal CORE Lecture August 27, 2008

2. What are some ‘true’ emergencies?

3. Topics 1.Necrotizing Fasciitis 2.Compartment Syndrome 3.Ischemic Limb / Amputated Part 4.Suppurative Flexor Tenosynovitis 5.Septic Joint 6.Major Burn

4. Necrotizing Fasciitis NF vs. NSTI Travels along fascial planes Types: –I –II –III

5. Necrotizing Fasciitis Appearance Presentation/CC Investigations (relevant)

6. Necrotizing Fasciitis Management –Surgical –Medical –Monitoring Long term plans

7. Compartment Syndrome Definition –Absolute vs. Relative Signs/Symptoms –Early vs. late –Most reliable sign –Most reliable symptom

8. Compartment Syndrome Investigations (relevant) ‘Whitesides’ technique Abdominal Compartment measurements

9. Compartment Syndrome Management –Know the anatomy! Closure options Late management

10. Ischemic Limb/Amputated Part Ischemic Limb –Why? –Acute vs. Chronic? Investigations Consults

11. Ischemic Limb/Amputated Part Traumatic ischemic limb –Management options Rheumatologic ischemic limb –Management options Medical Surgical

12. Ischemic Limb/Amputated Part Amputation –Mechanism of injury –Timing –Level of injury Investigations

13. Ischemic Limb/Amputated Part To replant or not to replant???? –Issues that will affect decisions

14. Suppurative Flexor Tenosynovitis Closed system Can spread quickly along sheath

15. Suppurative Flexor Tenosynovitis Presentation Signs/Symptoms –Kanavel’s 4 Findings –Most reliable sign Management –Medical –Surgical

16. Septic Joint Mechanism –Animal/human bite Examination –Position of joint –Most reliable way to test –Other associated conditions

17. Septic Joint Investigations Management –Surgical –Medical

18. Major Burn Definition Criteria for admission to a Burn Unit Management –Fluids ‘Parkland’ Assessing Depth

19. Major Burn Acute issues to deal with Consults Medical management Topical Management Surgical Management –timing