Unrecognized Injuries In A Plastic Surgery Practice

Emergency Medical Services are known for missing complaints that may have not been evident during the initial presentation.

Plastic surgeons are often called upon to evaluate and manage a wide scope of soft tissue injuries, as there is an extensive range of deformities in injuries that can result from trauma.

Damage to adjacent structures or organs are sometimes overlooked, even after a thorough evaluation by the initial practitioner.  

Occult injury to the facial bones should be considered when a neck injury is secondary to facial impact, such as airbag deployment.

Airbag deployment can specifically result in a number of injuries, causing not only ocular trauma, but orbital fractures, glaucoma, and retinal injuries.  

Frequently, small orbital fractures can occur and may not be appropriately diagnosed at the time of injury, but can cause significant problems for the patient later on.  

Basic radiographs may fail to reveal certain types of facial fractures, and early evaluation by a plastic surgeon can benefit the patient.  

For example, certain nasal fractures are not well visualized in imaging studies. Early evaluation by a plastic surgeon benefits the patient and assists in overall care.

Clinical correlation may be needed to detect a septal hematoma, a laceration of the nasal mucosa, or other findings, which may clinically support the diagnosis of a nasal fracture.Early clinical findings will assist the patient in ascertaining the sequelae of the facial injury.

Selected lasers may be of benefit in the management of traumatic skin injury after mechanical

disruption of the integumentary system. Multiple laser treatments may be necessary, and even after optimal management the patient may be left with residual scarring.

- THOMAS J. ZAYDON, JR., M.D.