Prophylactic Surgical Procedures in Plastic Surgery

2021 ◽  
pp. 325-358
Author(s):  
Ömer Faruk Dilek ◽  
Fuat Uslusoy ◽  
Mustafa Asım Aydın
Keyword(s):  
Plastic Surgery ◽  
Surgical Procedures ◽  
Prophylactic Surgical Procedures

Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1-positive or BRCA2-positive patients.

1998 ◽  
Vol 16 (3) ◽  
pp. 979-985 ◽  
Author(s):  
V R Grann ◽  
K S Panageas ◽  
W Whang ◽  
K H Antman ◽  
A I Neugut
Keyword(s):  
Quality Of Life ◽  
Ovarian Cancer ◽  
High Risk ◽  
Surgical Procedures ◽  
Brca2 Gene ◽  
Cost Effective ◽  
Prophylactic Surgery ◽  
Breast And Ovarian Cancer ◽  
Prophylactic Surgical Procedures

PURPOSE Young Ashkenazi Jewish women or those from high-risk families who test positive for BRCA1 or BRCA2 mutant genes have a significant risk of developing breast or ovarian cancer by the age of 70 years. Many question whether they should have prophylactic surgical procedures, ie, bilateral mastectomy and/or oophorectomy. METHODS A Markov model was developed to determine the survival, quality of life, and cost-effectiveness of prophylactic surgical procedures. The probabilities of developing breast and ovarian cancer were based on literature review among women with the BRCA1 or BRCA2 gene and mortality rates were determined from Surveillance, Epidemiology, and End Results (SEER) data for 1973 to 1992. The costs for hospital and ambulatory care were estimated from Health Care Financing Administration (HCFA) payments in 1995, supplemented by managed care and fee-for-service data. Utility measures for quality-adjusted life-years (QALYs) were explicitly determined using the time-trade off method. Estimated risks for breast and ovarian cancer after prophylactic surgeries were obtained from the literature. RESULTS For a 30-year-old woman, according to her cancer risks, prophylactic oophorectomy improved survival by 0.4 to 2.6 years; mastectomy, by 2.8 to 3.4 years; and mastectomy and oophorectomy, by 3.3 to 6.0 years over surveillance. The QALYs saved were 0.5 for oophorectomy and 1.9 for the combined procedures in the high-risk model. Prophylactic surgeries were cost-effective compared with surveillance for years of life saved, but not for QALYs. CONCLUSION Among women who test positive for a BRCA1 or BRCA2 gene mutation, prophylactic surgery at a young age substantially improves survival, but unless genetic risk of cancer is high, provides no benefit for quality of life. Prophylactic surgery is cost-effective for years of life saved compared with other medical interventions that are deemed cost-effective.

Plastic surgery

2018 ◽  
Author(s):  
Jonathan Warwick
Keyword(s):  
Plastic Surgery ◽  
Surgical Procedures ◽  
Free Flap ◽  
Breast Augmentation ◽  
Skin Grafting ◽  
Anaesthetic Management ◽  
Surgical Patients ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Surgical Operations

This chapter discusses the anaesthetic management of plastic surgery. It begins with general principles of the anaesthetic management of plastic surgical patients. Surgical procedures covered include breast augmentation, reconstruction, and reduction surgery, correction of prominent ears, facelift (rhytidectomy), free-flap surgery, liposuction, and skin grafting. The chapter concludes with a series of vignettes of minor plastic surgical operations.

Surgical Training in Camp Bastion, Afghanistan

2012 ◽  
Vol 98 (2) ◽  
pp. 23-27
Author(s):  
CA Fries ◽  
RF Rickard
Keyword(s):  
Resource Management ◽  
Plastic Surgery ◽  
Surgical Training ◽  
Surgical Procedures ◽  
General Surgery ◽  
Trauma Care ◽  
Orthopaedic Surgery ◽  
Surgical Trauma ◽  
Training Time ◽  
Critical Aspects

IntroductionSurgical trauma care on operations is delivered by consultants. The DMS presently delivers training to surgeons to enable them to deliver this care as newly-qualified consultants. Deploying as a trainee is one of many training evolutions available to achieve this competency. This paper describes the process involved in trainees deploying, and the training received by the first author (CAF) during a recent deployment.MethodsPre-deployment training and the process for gaining recognition of training time by the GMC are described. All surgical procedures performed by the first author were recorded prospectively, together with the level of supervision.ResultsThe first author performed 210 procedures in 124 operations on 87 patients in a seven week deployment. This was prospectively recognised for training by the GMC. All procedures were supervised by consultant trainers. Procedures included trauma surgical procedures and those under the specialties of Plastic Surgery, Orthopaedic Surgery and General Surgery.ConclusionsDeploying on operations as a trainee is invaluable in preparing DMS juniors for their future roles as consultants in the DMS. Training is received not only in a breadth of surgical and resuscitative procedures, beyond a trainee’s “base specialty”, but also in other critical aspects of deployments including Crew Resource Management.

scholarly journals Resident Exposure to Peripheral Nerve Surgical Procedures During Residency Training

2016 ◽  
Vol 8 (2) ◽  
pp. 173-179 ◽  
Author(s):  
Joseph A Gil ◽  
Alan H Daniels ◽  
Edward Akelman
Keyword(s):  
Peripheral Nerve ◽  
Plastic Surgery ◽  
Surgical Procedures ◽  
General Surgery ◽  
Orthopaedic Surgery ◽  
Case Volume ◽  
Peripheral Nerve Surgery ◽  
Case Logs ◽  
Nerve Surgery ◽  
Neurological Surgery

ABSTRACT  Variability in case exposures has been identified for orthopaedic surgery residents. It is not known if this variability exists for peripheral nerve procedures.Background  The objective of this study was to assess ACGME case log data for graduating orthopaedic surgery, plastic surgery, general surgery, and neurological surgery residents for peripheral nerve surgical procedures and to evaluate intraspecialty and interspecialty variability in case volume.Objective  Surgical case logs from 2009 to 2014 for the 4 specialties were compared for peripheral nerve surgery experience. Peripheral nerve case volume between specialties was performed utilizing a paired t test, 95% confidence intervals were calculated, and linear regression was calculated to assess the trends.Methods  The average number of peripheral nerve procedures performed per graduating resident was 54.2 for orthopaedic surgery residents, 62.8 for independent plastic surgery residents, 84.6 for integrated plastic surgery residents, 22.4 for neurological surgery residents, and 0.4 for surgery residents. Intraspecialty comparison of the 10th and 90th percentile peripheral nerve case volume in 2012 revealed remarkable variability in training. There was a 3.9-fold difference within orthopaedic surgery, a 5.0-fold difference within independent plastic surgery residents, an 8.8-fold difference for residents from integrated plastic surgery programs, and a 7.0-fold difference within the neurological surgery group.Results  There is interspecialty and intraspecialty variability in peripheral nerve surgery volume for orthopaedic, plastic, neurological, and general surgery residents. Caseload is not the sole determinant of training quality as mentorship, didactics, case breadth, and complexity play an important role in training.Conclusions

scholarly journals Antibiotic Prophylaxis in Plastic Surgery Correlation Between Practice and Evidence

2021 ◽  
pp. 229255032199700
Author(s):  
Peter Mankowski ◽  
Abhiram Cherukupalli ◽  
Karen Slater ◽  
Nick Carr
Keyword(s):  
Antibiotic Prophylaxis ◽  
Plastic Surgery ◽  
Surgical Procedures ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Evidence Based ◽  
Prescribing Practices ◽  
Surgical Prophylaxis

Background: The use of appropriate preoperative antibiotic prophylaxis decreases the risk of surgical site infections (SSI); however, the breadth of plastic surgery procedures makes it challenging to ensure appropriate use for each unique procedure type. Currently, plastic surgeons lack a cohesive and comprehensive set of evidence-based guidelines (EBG) for surgical prophylaxis. We sought to profile the perioperative antibiotic prescribing patterns for plastic surgeons in British Columbia to investigate if they are congruent with published recommendations. In doing so, we aim to determine risk factors for antibiotic overprescribing in the context of surgical prophylaxis. Methods: A literature review identifying EBG for antibiotic prophylaxis use during common plastic surgery procedures was performed. Concurrently, a provincial survey of plastic surgery residents, fellows, academic and community plastic surgeons was used to identify their antibiotic prophylaxis prescribing practices. These findings were then compared to recommendations identified from our review. The compliance of the provincial plastic surgery community with current EBG was determined for 38 surgical scenarios to identify which clinical factors and procedure types were associated with unsupported antibiotic use. Results: Within the literature, 31 of the 38 categories of surveyed plastic surgery operations have EBG for use of prophylactic antibiotics. When surgical procedures have EBG, 19.5% of plastic surgery trainees and 21.9% of practicing plastic surgeons followed recommended prophylaxis use. Average adherence to EBG was 59.1% for hand procedures, 24.1% for breast procedures, and 23.9% for craniofacial procedures. Breast reconstruction procedures and contaminated craniofacial procedures were associated with a significant reduction in adherence to EBG resulting in excessive antibiotic use. Conclusion: Even when evidence-based recommendations for antibiotic prophylaxis exist, plastic surgeons demonstrate variable compliance based on their reported prescribing practices. Surgical procedures with low EBG compliance may reflect risk avoidant behaviors in practicing surgeons and highlight the importance of improving education on the benefits of antibiotic prophylaxis in these clinical situations.

scholarly journals Soft tissue coverage types for complex limb trauma in children

2015 ◽  
Vol 10 (4) ◽  
pp. 348-354
Author(s):  
Ileana-Carmen MATLAC ◽  
◽  
Dan Mircea ENESCU ◽  
◽  
Keyword(s):  
Soft Tissue ◽  
Plastic Surgery ◽  
Surgical Procedures ◽  
Upper Limb ◽  
Soft Tissue Coverage ◽  
Local Flaps ◽  
Affected Area ◽  
Children's Hospital ◽  
Limb Trauma ◽  
Minimum Age

Objective. The analysis of the soft tissue coverage types employed in complex limb trauma in children towards a potential subsequent optimization of their management. Materials and methods. Data regarding the children admitted to the Burns and Plastic Surgery Clinic of ‘Grigore Alexandrescu’ children’s hospital, between 2005 and 2013 with complex limb trauma requiring soft tissue coverage was obtained from the surgical protocols. Information was gathered regarding patients’ sex and age, the type of incident, the mode of occurence, the region in need of coverage, the number and type of surgical procedures, as well as regarding the type of coverage employed. Results. A number of 80 children required soft tissue coverage in complex limb trauma. Boys accounted for approximately two thirds of all cases. The pacients had a minimum age of 1 year and a maximum one of 16 years. There were approximately 50% more trauma of this type affecting the upper limb than the lower one. The fingers required coverage in the majority of cases (77.5%). In the majority of cases at this level (77%) split-level thickness grafts and local flaps were applied. Conclusions. The majority of the complex pediatric soft tissue limb coverage cases were boys. Fingers were the predominantly affected area and most often the usage of split-level thickness grafts or of local flaps was required. The accidents were predominantly home related. The cases had an uncomplicated evolution, the coverage solutions employed being successful in over 90% of the situations.

Prophylactic Surgical Procedures for Esophageal Pathologies

2021 ◽  
pp. 141-152
Author(s):  
Osman Nuri Dilek ◽  
Halis Bağ ◽  
Mustafa Ufuk Uylaş ◽  
Serkan Karaisli
Keyword(s):  
Surgical Procedures ◽  
Prophylactic Surgical Procedures

Implant Plastic Surgery: A Review and Rationale

2004 ◽  
Vol 30 (4) ◽  
pp. 240-254 ◽  
Author(s):  
Christopher E. Kazor ◽  
Khalaf Al-Shammari ◽  
David P. Sarment ◽  
Carl E. Misch ◽  
Hom-Lay Wang
Keyword(s):  
Soft Tissue ◽  
Plastic Surgery ◽  
Surgical Procedures ◽  
Treatment Modality ◽  
Clinical Success ◽  
Clinical Applications ◽  
Success Rates ◽  
Case Selection ◽  
Implant Dentistry

Abstract Implant dentistry has been established as a predictable treatment modality with high clinical success rates. Esthetic considerations of implant restorations have been gaining increased interest over the years. The role of periodontal plastic surgical procedures in the creation and maintenance of peri-implant soft tissue heights to facilitate better esthetics has become more popular. The available plastic surgery procedures and their clinical applications are reviewed in this article. Emphasis is placed on factors to consider for proper case selection and ideal treatment planning.

scholarly journals Surgical treatment of locally advanced vulvar cancer

2021 ◽  
Vol 10 (3) ◽  
pp. 20-25
Author(s):  
A.  A. Mukhin ◽  
A.  V. Vazhenin ◽  
V.  V. Saevets ◽  
A.  V. Taratonov
Keyword(s):  
Surgical Treatment ◽  
Plastic Surgery ◽  
Surgical Procedures ◽  
Surgical Procedure ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Advantages And Disadvantages ◽  
Reconstructive Plastic Surgery ◽  
Reconstructive Techniques ◽  
Reconstructive Plastic

The article discusses the choice of different surgical procedures in patients with locally advanced vulvar cancer, depending on the volume of resected tissues and the possibility of reconstructive plastic surgery. The advantages and disadvantages of various plastic reconstructive techniques are provided. The issue of wound closing after the vulvectomy and the plastic techniques has always been controversial and led to the sophistication of the reconstructive component, as well as to the limitations or refusal of this surgical procedure use.

Sign in / Sign up

Export Citation Format

Share Document