Plastic surgery

Elective and emergency plastic surgical patients make up a significant proportion of cases in paediatric anaesthesia. Frequently, patients are fit and well, the surgical site is peripheral, and the surgery is done in normal working hours as a day case. Certain presentations such as syndactyly or congenital microtia may be part of a syndrome, and anaesthesia for surgery in these patients may present specific difficulties for the paediatric anaesthetist. Laser treatment for pigmented lesions or scars may present a challenging working environment, and anaesthesia for free flap reconstructive surgery challenges the anaesthetist to provide optimum conditions for graft success. Acute trauma, including small burns and scalds, is common in children and is usually minor. Major burns require a structured approach in resuscitation, surgical and anaesthetic management, and aftercare, including pain management.