The decision to refer depends on the doctor's experience, skill level, and ability to give the time necessary to do a good job. In general, wounds or injuries that will require extensive follow up, or additional surgery might better be referred at the start. The primary care physician should develop a relationship with specialists that can provide emergency and elective services when needed. The ideal specialist should be able to discuss the case over the phone and give some direction as to whether referral is indicated. She should also be willing to back you up in cases where something has gone wrong despite good care.

INDICATIONS FOR REFERRAL
Patient request.

• Deep injury, such as nerves, tendons, bones underlying a laceration.
  
  
• Difficult wounds, such as full thickness eyelid, lip or ear lacerations.
  
  
• Wounds with a high likelihood of an unacceptable result-severe crush injuries, heavy contamination, unrealistic patient.
  
• Wounds that you feel uncomfortable in treating.

HOW CAN PLASTIC SURGEONS HELP?
Most people are aware that plastic surgeons can take care of lacerations and scars. Fewer are aware that plastic surgeons also take care of facial and jaw fractures. Many plastic surgeons treat hand injuries including fractures, nerve and tendon injuries. Plastic surgeons also are capable of reattaching amputated body parts, such as fingers, ears and even the penis.