Table 2.

Indications for Referral and Initial Management

Indications for ReferralInitial Management in the Office
Hand burnPartial-thickness burns >10% of TBSAApply dressings including bacitracin, mafenide acetate (sulfamylon), mupirocin (Bactroban), aquacel, biobrane, hydrocolloids, mepilex, xeroform, or acticoat7
Third-degree burns
Burns involving major joints
Chemical or electrical burns
Inhalation injury or concomitant trauma
Special social, emotional, or rehabilitation needs
Trigger fingerConservative and steroid treatments show no improvements. Provider is not comfortable with steroid injection to the stenosing tenosynovitis.Activity modification
Short-term nonsteroidal anti-inflammatory drugs
Hand lacerationBiteNeurovascular exam
Laceration caused by teethSensory exam
Capillary refill greater than 2 secondsMotor exam
Exposed bonesAchieve hemostasis with pressure
Contamination, early infection, and associated fracturesIrrigation with sterile or tap water
Provider unable to close the soft tissueSoft-tissue closure
Pressure ulcersStage 3 and 4 woundsWound evaluation and staging
Bleeding control
Pressure reduction
Correct any existing malnutrition
Occlusive dressings
Venous woundsNecrotic tissue debridementCompression and leg elevation
Arterial woundsWound with poor perfusionLeg elevation
No improvements with conservative treatmentManagement of modifiable risk factors
Diabetic woundsRefractory to conservative treatmentsWound culture
Deep ulcers reaching muscle or bony tissueAntibiotic therapy
Dressing changes
Patient education
Management of risk factors
LymphedemaStage IIIDecongestive therapy
Patient education
Skin tearsOpen fractures, tendon, nerve, muscle lesions, or skin tears in the eyelidsMoist dressings: aquaphor, hydrogel, or bacitracin.
Delayed healing (> 21 days)Encourage fluid intake
Scar managementScars present for more than 1 yearStructured scar assessment
A concerning scar assessmentSubjective evaluation
Keloids, recurrent scars, contracture scars, atrophic scars, widespread scars, or patients with a positive family history of abnormal scarringCompression therapy
Dynamic and static splints
  • TBSA, Total body surface area.