As a parent, it's practically inevitable that some day you will wind up in the emergency room or urgent care with a child who has suffered some type of trauma. Often, a child's wounds can be managed by the ER staff, but there are times when you might want to request a plastic surgery consult. How do you know when to ask the emergency staff to call a plastics specialist? Here are four scenarios where you should feel comfortable asking for a plastic surgeon if one isn't offered to you, and what you can expect in general about requesting plastic surgeons in the ER.  

Severe Trauma

The most obvious need for a plastic surgeon is if your child incurs severe trauma, such as that from a dog bite or a motor vehicle accident. In this instance, the ER staff will likely call the plastic surgeon even before you bring it up.

These types of accidents can leave large deformities if not handled carefully. Things like missing tissue, skin flaps, underlying fractures, and dental damage are all issues that are more familiar to repair by a plastic surgeon than an emergency physician. In cases where there might be large-scale damage to nerves, bone, blood vessels, or muscle tissue, a plastic surgeon may work in conjunction with other specialists, such as microsurgeons or craniofacial physicians.

Full-thickness Wound

Sometimes even a straight laceration (cut) can be better sutured by a plastic surgeon than an ER doc. In the case of full-thickness lacerations, where the wound might extend all the way to the bone, a plastic surgeon can reduce the amount of unsightly scarring that accompanies stitching multiple layers of tissue. There is also the risk of damage to vascular and nerve structures with this depth of a wound, which is better addressed by a plastics specialist.

Location of Wound Has Cosmetic Consequences

Usually, most kids who have a scar on the knee or arm don't think much about it. However, a wound to the face can affect a child's appearance more drastically and can even have an impact on the function of facial structures. A wound that requires more than one or two stitches near the eyes, nose, or mouth is typically best sutured by a children's plastic surgeon.

Child Prone to Excessive Scarring

Do you know from experience or genetics that your child is prone to heavy scarring or keloids? This is another situation where a call to the plastic surgeon wouldn't be out of line.   

Be aware that ER physicians do stitch up lots of kids on a daily basis, and they may be able to handle wounds even when you think a plastic surgeon is needed. Suturing by a plastic surgeon does not mean there will not be any scar, merely that the chances of a more noticeable scar can be reduced.

Furthermore, sometimes a plastic surgeon is not available, due to demands elsewhere in the facility. You may wind up with a surgical intern or have to wait a long time, which could be stressful for your child.

Finally, if you call for a plastic surgeon, don't be surprised if your bill is higher than it would be otherwise. You may receive an extra charge for a second physician's work. If, however, your child's health or self-image would be better served by being treated by a plastic surgeon, this additional cost may well be worth it.