Plastic & Hand Surgery

Who to refer:

Urgent referrals should be made for patients with:

• Skin cancer
• Soft tissue trauma
• Burns

Non-urgent referrals should be made for the following conditions.

• Benign skin lesions – many lesions will not be removed in secondary care, please refer to the additional information for further guidance.
• Congenital anomalies such as cleft, ear/face, limb, hypospadias, vascular malformations and birthmarks.
• Disfigurement resultant from trauma, infection or medical conditions
• Hand conditions such as dupytrens, carpal tunnel, rheumatoid arthritis.  Please refer to the hand page for more detailed information on making referrals for these conditions.  
• Post cancer reconstructive surgery including eyelids, face & breast
• Scar Management

Who not to refer:

• Patients seeking cosmetic or aesthetic surgical enhancement.  In November 2011 the Exceptional Aesthetic Referral Protocol and Pathway were updated and a copy can be found at this link – (pdf) These guidelines formalise a list of conditions for which the NHS will not usually offer surgery.  A list of exclusion criteria have been defined, which if met, will indicate that surgery is appropriate. You will still be at liberty to refer patients in cases where you consider there to be exceptional circumstances.  An example might include severe and prolonged psychological distress.  However these patients will in the first instance be seen by a designated clinical psychologist and will only be referred on for plastic surgery assessment if they have sufficient mental health grounds for surgery and have no psychological contraindications to surgery.  Referrals must be made using the Exceptional Aesthetic Referral protocol (see below).  
• Facial Hirsutism.  Referrals should only be made for patients where there has been a confirmed diagnosis of polycystic ovary syndrome and there is excessive male pattern hair growth (not hairline, eyebrows or upper lip) and in patients.  Please note that blonde/white hair does not respond and red hair has a poor response.  Referrals should be made using SCI Gateway. 

How to refer:

Referrals should be made via the SCI gateway: St John’s Hospital>Plastic Surgery.

Please note that non-Lothian GPs should always refer to their local centre first unless there are specific arrangements in place. 

Please note that referrals for patients with conditions under the Exceptional Aesthetic Referral Protocol should be made via SCI Gateway: St John’s Hospital>Plastic Surgery>L Exceptional Aesthetic Referral.

• Information to include with the referral

• Referrals should be made via SCI Gateway SJH>Plastic Surgery

• National Institute for Health and Care Excellence (NICE)
• Scottish Intercollegiate Guidelines Network (SIGN)