TRAUMA, ACCIDENTS & EMERGENCIES

Accidents and Emergency is a very common arena for a Plastic Surgeon. Plastic surgical input into accident emergency services at major teaching hospitals is among the busiest of all the sub-specialities of surgery.

During my training, many hours were spent in the Accident and Emergency Departments around Sydney as well as operating on these patients. Following four years of training and fourteen years spent as a VMO at St Vincents Public Hospital and doing a 1 in three to four on-call roster, I have had enormous experience with Accident and Emergency cases. These cases include thousands of hand injuries, burns, facial fractures, facial lacerations, scalp, penile and finger replantations.

I have dealt with many dog bites as well as reconstructing major tissue losses following car accidents. Accident injuries are second nature to me and I still enjoy dealing with them. I am however not on-call at St Vincents Public Hospital anymore, and as such only see certain injuries in my office when I am referred them.

Facial lacerations and hand injuries

I often clean and suture facial lacerations and fix hand injuries. For facial lacerations these injuries are not excessively urgent unless there is profuse bleeding. These lacerations can be covered and dealt with within 24 hours and as such one would not need to wait in the Accident and Emergency rooms for long periods.

I see a lot of patients with facial lacerations who have come from Accident and Emergency departments and don’t realise that the laceration does not have to be sutured immediately, it can wait for an expert to do it later or the following day with vastly superior outcomes.

Facial lacerations rarely get infected. If a laceration has been sutures in an Accident and Emergency service and, to be fair they have not the training to do an excellent repair, then within a few days these lacerations can be resutured by a professional.

If weeks have gone by and the wounds have healed it is best to review the wound and then decide either to allow for it to mature before revising the scar.

A few final words

Plastic surgeons are thus the best speciality to be involved with soft tissue injuries anywhere on the body. These include face, hand, abdomen and legs be they burns, abrasions, lacerations, abscesses, deglovings, tendon or nerve injuries. I have a vast knowledge to deal with all of these emergency type cases.

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