This document summarizes a study conducted at an inner city university hospital emergency department and level 1 trauma center. Over a 4 month period, the study collected data on 79 plastic surgery consultations for injuries excluding trauma. The majority of consultations were for hand injuries, including 14 bony injuries, 25 soft tissue injuries, and 15 complex hand injuries. Head and neck injuries included 4 bony injuries, 9 soft tissue injuries, and 3 complex injuries. Other injuries included soft tissue injuries to the leg, trunk, and upper extremities. The study found that all cases required specialist consultation and were appropriate for plastic surgery. Digital imaging was found to provide sufficient information for consultations and store and forward technology could make consultations more efficient. The

1. Ian Hoppe, MD
Mark Granick, MD, FACS
Department of Surgery (Plastic)
New Jersey Medical School
Newark, New Jersey, USA

2. Plastic Surgeons in the
Emergency Department
 Top 5 consultant
service
 Hand injuries
 Acute wounds
 Facial fractures
 Hardest service to get
 Resident complaints

3. Study of PS Consultations
 Inner city university hospital ED
 Level 1 Trauma Center
 4 month study period
 Collect digital images and basic data on all ED
consults, no Trauma consults
 Analyzed by store and forward technology

4. Findings
 79 consults
 66 male, 13 female, 2-71 years old, mean 35
 Hand injuries
 14 bony
 25 soft tissue
 15 complex
 Head and Neck injuries
 4 bony
 9 soft tissue
 3 complex
 Other injuries – all soft tissue
 1 leg
 2 trunk
 5 upper extremity

5. Findings
 Head and Neck injuries
 4 bony
 9 soft tissue
 3 complex
 Other injuries – all soft tissue
 1 leg
 2 trunk
 5 upper extremity

6. Spectrum of Injuries
Hand - bony Hand – soft tissue Hand -complex Facial - bony
Facial- soft tissue Facial - complex

7. Assessment
 All cases required specialist consultation
 All cases appropriate for Plastic Surgery
 All cases educational for the residents

8. What happened to all the
other cases?
Incorrect ulnar gutter splint Ineffective thumb spica
Sent to Plastic Surgery Clinic
374 patients seen in clinic with 44 no shows
154 of the 374 seen were ED referrals

9. QA Analysis
 All patients referred
were appropriate
 Numerous patients
missed
 First therapeutic
intervention is critical
 Better to call than to
treat a late
complication

10. Recommendations
 Digital imaging provides sufficient information to make an
accurate assessment
 Store and Forward analysis can make ED consultation more
efficient and more effective
 Digital image review is an appropriate QA tool
 Develop telemedical/telehealth system with specialists to insure
proper initial care
 Patient privacy
 Medical Licensing
 Malpractice
 International and regional legal boundaries
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