Epidemiology of plastic surgery trauma in people with associated drug and alcohol dependence: developing guidelines for optimal treatment

Abstract

People addicted to drugs or alcohol are commonly referred to the plastic surgery department. We describe the challenges and epidemiology of injuries in this group and suggest an algorithm for optimal management. A retrospective study was carried out of medical records of people with drug and alcohol problems treated in the plastic surgery unit between January 2004 and December 2007 inclusive is presented. Exclusion criteria: (1) elective admissions, (2) previous, but not current drug or alcohol use, (3) a short history of excessive alcohol intake, (4) isolated burn injuries, and (5) no notes available. Injuries were sustained by 77 people. Males (64) were more commonly referred than females (13), with a mean age of 37 years (20–65) at presentation. Delayed presentation (17/77) and non-compliance with treatment (16/77) was common. Only six patients were employed, nine were homeless and two lived in prison. Psychiatric illness was commonly encountered (16/77). Trauma (26), self-harm (16), assault (14), and inadvertent injury (13) were all more common than injury directly due to injection (8). Thirteen patients self-discharged from the ward prior to completion of treatment and 61(79%) did not complete follow-up. A holistic approach of people with drug and alcohol addiction and injury is required including early referral to social services, drug and alcohol teams. Our clinical guidelines recommend single-stage treatment, early education and advice for patients to achieve an optimal outcome.