TIPS In Plastic Surgery

These diagrams and illustrations have been designed to help you learn, memorise and recall key information.

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Primary management in the emergency department

Principal recommendations 


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• Initial assessment and treatment of the patient occurs simultaneously and in accordance with Advanced Trauma Life Support (ATLS®) principles. 


• Assessment of the open tibial injury is systematic, careful and repeated in order to identify established or evolving limb-threatening conditions and to document limb status prior to manipulation or surgery. 


• Haemorrhage control is through direct pressure or, as a last resort, application of a tourniquet. 


• Wounds are handled only to
a. Remove gross contaminants b. Photograph for record
c. Seal from the environment. 


• Wounds are not ‘provisionally cleaned’ either by: a. exploration
b. irrigation. 


• Limb splintage is the most appropriate means of immobilisation available in the Emergency Department. Provisional external xators are not applied. 


• Antibiotic and anti-tetanus prophylaxis is given. 


• In addition to two orthogonal views of the tibia, radiographic assessment includes the knee and ankle joints.