Plastic Surgeon Expert Witness

Unrecognized Injuries In A Medical Practice
By a plastic surgeon from Florida

All physicians/general practitioners/specialists are often called upon to evaluate and manage a wide scope of soft tissue injuries.

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

The prudent practitioner will consider a plastic surgical evaluation, but fully evaluating certain types of trauma.

Neck trauma is sometimes associated with injury to the maxillofacial skeleton. Early diagnosis and treatment is key to an optimal patient outcome. Injury to the facial bones should be considered when a neck injury is secondary to the facial impact, such as airbag deployment.

Although radiographs are of benefit in the initial triage of facial fractures, a CT scan or MRI may be needed to fully evaluate the injury. Sometimes a nasal fracture is not well visualized and early evaluation by a plastic surgeon benefits the patient and assists in the overall care. Since radiographs may fail to reveal a nasal fracture, early evaluation by a plastic surgeon can detect clinical conditions, such as a septal hematoma, laceration of the nasal mucosa, or other findings, which may clinically support the diagnosis of a nasal fracture.

Any impact to the mandible may disrupt the mechanics of the temporomandibular joint. Prompt and thorough evaluation by a colleague familiar with the mandible and its relation to the remainder of the facial skeleton is key to providing an optimal patient outcome. Early clinical findings will assist the patient in ascertaining the sequelae of the facial injury.

Approximately 5-10% of American women have had breast implants. If trauma to the chest is significant, the breast prostheses may be affected. Early evaluation by a plastic surgeon can help establish that diagnosis. It is especially helpful that the patient be evaluated by a physician who is familiar with the patient’s pre-traumatic anatomy. If this is not possible, then early evaluation would be of benefit to document external contusions, bruises, or subcutaneous fluid collections. Clinical examination, along with an MRI of the breasts, can assist in the understanding of whether the underlying breast implant(s) has been disrupted or ruptured after trauma.

Airbag deployment can result in abrasions of the skin. This is the result of the release of noxious chemicals and mechanical disruption of the protective layers of the skin. This may result in compromise of the protective functions of the skin.

Certain lasers may be of benefit in the management of skin sequelae after mechanical disruption of the deeper layers of the skin. Multiple laser treatments are usually necessary, however, even after optimal management the patient is commonly left with some permanent scarring.

Soft tissue impact may result in seromas. Often, these subcutaneous fluid collections resolve spontaneously, however, they can persist, resulting in pseudobursa formation. This condition may require intervention by a physician trained in the various methods of management, which may include surgery. An MRI is of some benefit in the diagnosis of post-traumatic seromas.

Plastic surgeons are often called upon to evaluate scars after trauma. Often overlooked are “future” scarring, which will result after medically necessary surgical intervention, such as orthopedic surgery to the shoulder or hip. Any surgical procedure, regardless of site, technique (open versus closed), or patient, will result in some degree of scarring. The degree of scarring is, to some extent, unpredictable. However, under no circumstances can any sort of intervention be performed without leaving some evidence of its having taken place.

Finally, finding a well qualified plastic surgeon is key to good patient care. The surgeon should be certified by the American Board of Plastic Surgery. This is the only plastic surgical board recognized by the American Board of Medical Specialties. He or she should have privileges at a local hospital.

Most importantly, an effective plastic surgeon who produces a good patient outcome is frequently a thorough and compassionate physician, who is comfortable in the evaluation of a wide range of deformities that can result from trauma.

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