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Plastic surgery minor procedure room: a cost-effective way to operate 整形外科小手术室:经济高效的手术方式
Pub Date : 2024-07-23 DOI: 10.34239/ajops.93016
B. Sacks, Xinchen Gu, S. Shoukath, Nigel C Mann
Introduction: Surgery using local anaesthetic without sedation outside of a formal operating theatre is particularly applicable to plastic surgery. This paper reviews the benefits and pitfalls of a minor procedure room as a novel solution to tackling the emergency and elective surgery caseload in a tertiary metropolitan plastic surgery unit. Methods: From February 2022 until February 2023 local anaesthetic only procedures were undertaken in a minor procedure room. Patients included ranged from 18 to 88 years of age. Outcomes included complications and procedure failure requiring repeat procedure in an operating theatre. Estimated cost savings were calculated according to staff wages and do not account for consumables. Estimated duration of minor procedure room operation was one hour per case. Results: Overall, 350 patients (285 male, 65 female) underwent local anaesthetic only procedures in the minor procedure room. The mean age of patients was 42. There were 309 hand/upper limb cases, 31 general plastic surgery cases, two skin cancer excisions and eight lower limb cases. There were no complications and no procedure failures. The average cost saved per procedure is estimated to be AU$486 with an average reduction of 44 theatre sessions per year. Conclusion: A minor procedure room for local anaesthetic only surgery can generate significant cost and time savings for a hospital when implemented and managed appropriately. This model has been successful in our institution and can likely be replicated in other centres.
导言:在正规手术室外使用局部麻醉但不使用镇静剂的手术尤其适用于整形外科。本文回顾了小手术室的优点和缺陷,它是解决大都市三级整形外科急诊和择期手术量的一种新方案。方法:从 2022 年 2 月到 2023 年 2 月,小手术室只进行局部麻醉手术。患者年龄从 18 岁到 88 岁不等。结果包括并发症和手术失败,需要在手术室重复手术。估计节省的成本按员工工资计算,不包括消耗品。小手术室手术的估计持续时间为每例一小时。结果:共有 350 名患者(285 名男性,65 名女性)在小手术室接受了局部麻醉手术。患者的平均年龄为 42 岁。其中手部/上肢手术 309 例,普通整形外科手术 31 例,皮肤癌切除术 2 例,下肢手术 8 例。没有并发症,也没有手术失败。每项手术平均节省成本约为 486 澳元,每年平均减少 44 次手术。结论如果实施和管理得当,只进行局部麻醉手术的小手术室可为医院节省大量成本和时间。这种模式在我们医院取得了成功,并有可能在其他中心推广。
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引用次数: 0
Management of close/positive margins in cutaneous squamous cell carcinoma of the head and neck: a systematised review 头颈部皮肤鳞状细胞癌切缘闭合/阳性的处理:系统化综述
Pub Date : 2024-07-16 DOI: 10.34239/ajops.88849
Luke Martin, M. Cabalag, Anand Ramakrishnan, Andrew Martin
Introduction: The authors reviewed close/positive margins in cutaneous squamous cell carcinoma of the head and neck, ensuing recurrence, regional or systemic metastasis, mortality and follow-up management. Methods: The design was a systematised review from January 2000 to July 2021. The MEDLINE database was searched with 15 articles out of 3104 meeting the inclusion criteria. Pertinent references underpinning the National Comprehensive Cancer Network’s Squamous Cell Skin Cancer Guidelines Version 2.2022 were reviewed. Results: Overall, there were 13,671 cutaneous squamous cell carcinoma lesions. We found pooled rates for positive excision (14.6% at 99% CI [12.97, 16.26]), ensuing recurrence (14.7% at 99% CI [13.51, 15.83]), regional or systemic metastasis (33.8% at 99% CI [33.77, 33.87]), and mortality (46.6% at 99% CI [42.53, 50.65]). Positive excisions most frequently involved the deep margin (73.7%), nose (34.5%) and ear (33.14%). Re-excision of positive margins appeared to confer worse recurrence (35.4%). We found pooled rates for close/positive excision (17% at 99% CI [15.22, 18.84]), ensuing recurrence (17% at 99% CI [15.76, 18.16]), regional or systemic metastasis (30.4% at 99% CI [26.15, 34.73]), and mortality (46.6% at 99% CI [42.53, 50.65]). Mean follow up was 51 months. Surgical re-excision with adequate margins appeared to be most efficacious, followed by radiotherapy. Chemoradiation and chemotherapy appeared less efficacious. Conclusion: Surgical re-excision with adequate margins remains the gold standard for close/positive margins in cutaneous squamous cell carcinoma of the head and neck, followed by radiotherapy.
导言:作者回顾了头颈部皮肤鳞状细胞癌的切缘闭合/阳性、复发、区域或全身转移、死亡率和后续管理。研究方法设计了2000年1月至2021年7月的系统回顾。在 MEDLINE 数据库中搜索了 3104 篇文章,其中 15 篇符合纳入标准。对美国国家综合癌症网络鳞状细胞皮肤癌指南 2.2022 版的相关参考文献进行了回顾。结果:总共有 13,671 例皮肤鳞状细胞癌病变。我们发现了阳性切除率(14.6%,99% CI [12.97,16.26])、随后复发率(14.7%,99% CI [13.51,15.83])、区域或全身转移率(33.8%,99% CI [33.77,33.87])和死亡率(46.6%,99% CI [42.53,50.65])。阳性切除最常涉及深边缘(73.7%)、鼻部(34.5%)和耳部(33.14%)。再次切除阳性边缘似乎会导致更严重的复发(35.4%)。我们发现,近端/阳性切除术(17%,99% CI [15.22,18.84])、随后复发(17%,99% CI [15.76,18.16])、区域或全身转移(30.4%,99% CI [26.15,34.73])和死亡率(46.6%,99% CI [42.53,50.65])的汇总率。平均随访时间为 51 个月。有足够边缘的手术再切除似乎最有效,其次是放疗。化学放疗和化疗的疗效较差。结论是对头颈部皮肤鳞状细胞癌来说,手术再切除并保留足够的切缘仍然是切缘接近/阳性的金标准,其次是放疗。
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引用次数: 0
The modified Stack procedure for central slip reconstruction: a case series 改良斯塔克手术用于中央滑移重建:病例系列
Pub Date : 2024-07-09 DOI: 10.34239/ajops.92997
James Warbrick-Smith, Holly Morris, Shirley Collocott, Amy Wang, Karen L Smith
There are many surgical techniques for reconstruction of the divided or incompetent central slip. Most rely upon postoperative immobilisation to protect the repair. We present our experience using a distally based flexor digitorum superficialis slip to reconstruct the central slip and allow early mobilisation in five patients with intact preoperative intrinsic function. Post-treatment, a mean recovery of 65 degrees of active extension was achieved, albeit at the cost of a mean 22-degree loss of active flexion. We suggest this relatively easy technique provides a useful surgical option in the management of this difficult problem.
有许多手术技术可以重建分裂或功能不全的中央滑脱。大多数都依赖术后固定来保护修复。我们介绍了使用远端屈指肌浅滑脱重建中央滑脱的经验,并允许术前内在功能完好的五名患者尽早活动。治疗后,患者的主动伸展功能平均恢复了 65 度,但主动屈曲功能平均丧失了 22 度。我们认为这种相对简单的技术为治疗这一疑难问题提供了有用的手术选择。
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引用次数: 0
The importance of ward-based education in the postoperative assessment of free flaps 病房教育在游离皮瓣术后评估中的重要性
Pub Date : 2024-07-02 DOI: 10.34239/ajops.90089
G. D. Dounas, J. Willet, Anton I Alvaro, Lucinda Van de Ven, Mjd Wagstaff
Background: Despite the theoretical and practical advantages of adjunct-based free flap failure detection, the introduction of ultrasonographic techniques has not changed free flap failures rates and their use remains secondary to clinical assessment. Our study aims to develop an educational framework to improve the confidence of nursing staff caring for free flaps, with an emphasis on early detection of flap failure, thereby improving postoperative outcomes. Methods: Nursing staff in intensive care units and surgical wards caring for free flaps completed standardised questionnaires either before or after an educational seminar detailing clinical and Doppler assessment of free flaps. Differences between cohorts were summarised descriptively with frequencies and percentages. Overall confidence scores for pre-education and post-education cohorts were compared. Results: Overall, 173 responses were collected. Most staff were from intensive care units (n = 114) and almost one-third completed surveys following the educational intervention (n = 51). Microsurgical ward staff had more experience in the postoperative care of free flaps than intensive care unit staff (29% vs 18% had experience caring for > 50 free flap cases). Confidence in assessing a free flap by clinical, implantable Doppler or external Doppler ultrasound was universally increased among ward staff compared to intensive care unit staff (p ≤ 0.007). Altogether, 51 per cent of intensive care unit staff had never identified a failing flap compared with 35 per cent of ward staff. Education increased confidence in managing and escalating failing flaps unanimously. Most failing flaps were identified by clinical assessment alone or combined with adjunct-based methods (94%). Conclusion: This study demonstrates that the provision of targeted education for nursing staff, both in intensive care units and on surgical wards, is useful for increasing confidence in the clinical assessment and early detection of free flap compromise. Increased confidence and improved clinical assessment may allow for early intervention and improved salvage rates for a threatened free flap, thereby improving patient outcomes.
背景:尽管基于辅助手段的游离皮瓣失败检测具有理论和实践上的优势,但超声技术的引入并未改变游离皮瓣的失败率,其使用仍是临床评估的次要手段。我们的研究旨在制定一个教育框架,以提高护理人员护理游离皮瓣的信心,重点是早期发现皮瓣失败,从而改善术后效果。研究方法重症监护室和外科病房负责护理游离皮瓣的护理人员在参加详细介绍游离皮瓣临床和多普勒评估的教育研讨会之前或之后填写了标准化问卷。各组之间的差异以频率和百分比进行描述性总结。比较了教育前和教育后组群的总体信心分数。结果:共收集到 173 份回复。大多数员工来自重症监护病房(n = 114),近三分之一的员工在教育干预后完成了调查(n = 51)。显微外科病房的医护人员在游离皮瓣术后护理方面比重症监护病房的医护人员更有经验(29% 比 18% 有超过 50 例游离皮瓣护理经验)。与重症监护室人员相比,病房人员通过临床、植入式多普勒或体外多普勒超声评估游离皮瓣的信心普遍提高(p ≤ 0.007)。与 35% 的病房员工相比,51% 的重症监护室员工从未发现过失败的皮瓣。教育一致增强了管理和升级失败皮瓣的信心。大多数失败的皮瓣都是通过单独的临床评估或结合辅助方法(94%)发现的。结论:这项研究表明,为重症监护病房和外科病房的护理人员提供有针对性的教育,有助于提高他们对临床评估的信心,并及早发现游离皮瓣受损的情况。信心的增强和临床评估的改进可实现早期干预,提高受威胁游离皮瓣的挽救率,从而改善患者的预后。
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引用次数: 0
The obesity paradox in patients with major burn injuries: a single tertiary burn centre review 重度烧伤患者的肥胖悖论:一家三级烧伤中心的回顾
Pub Date : 2024-06-11 DOI: 10.34239/ajops.90090
Michaela Pollock, Eldo Paul, Cheng Hean Lo
Introduction: The obesity paradox is a phenomenon described in medical literature where overweight and obese patients have improved survival and better health outcomes. The obesity paradox is of curiosity to many clinicians as the general consensus in medicine has been that a higher body mass index results in poorer health outcomes in both medical and surgical conditions. The aim of this study is to determine whether the obesity paradox exists in our patients with major burn injuries. To our knowledge, this has not been previously investigated in the Australian major burn population. Methods: This is a retrospective study involving patients with major burn injuries > 20 per cent total body surface area admitted to the Victorian Adult Burns Service (Melbourne, Australia) from 1 January 2016 to 31 December 2020 (five-year period). Information collected included patient demographics, weight and height, and nature of burn injuries. Primary outcome of interest was inpatient mortality, and secondary outcomes included hospital length of stay, intensive care unit length of stay, duration of ventilation support required and presence of bacteraemia. Results: A total of 1704 patients were admitted, of whom 165 patients met inclusion criteria for analysis. The vast majority of 31 patients (18.8%) who died during admission were palliated. The obesity paradox did not exist in this study population. Furthermore, although not statistically significant, higher levels of body mass index showed increased risk of mortality. There was no significant association between body mass index and hospital length of stay (p = 0.16), intensive care unit length of stay (p = 0.72), duration of ventilation support (p = 0.62) nor bacteraemia (p = 0.68). Conclusion: The emerging evidence regarding the obesity paradox in the burn surgery literature is inconsistent. We contend that differences in burn management, including palliation of patients with major burn injuries, contribute to these findings.
简介肥胖悖论是医学文献中描述的一种现象,即超重和肥胖患者的生存率更高,健康状况更好。肥胖悖论令许多临床医生感到好奇,因为医学界的普遍共识是,无论是内科还是外科手术,体重指数越高,健康状况越差。本研究的目的是确定我们的重度烧伤患者是否存在肥胖悖论。据我们所知,以前从未在澳大利亚重度烧伤人群中进行过这方面的调查。研究方法:这是一项回顾性研究,涉及 2016 年 1 月 1 日至 2020 年 12 月 31 日(五年期间)维多利亚州成人烧伤服务机构(澳大利亚墨尔本)收治的体表总面积大于 20% 的重度烧伤患者。收集的信息包括患者的人口统计学特征、体重和身高以及烧伤性质。主要研究结果为住院患者死亡率,次要研究结果包括住院时间、重症监护室住院时间、所需通气支持时间以及是否存在菌血症。结果:共收治了 1704 名患者,其中 165 名患者符合纳入分析的标准。在入院期间死亡的 31 名患者(18.8%)中,绝大多数都得到了缓解。肥胖悖论在本研究人群中并不存在。此外,虽然没有统计学意义,但体重指数越高,死亡风险越大。体重指数与住院时间(p = 0.16)、重症监护室住院时间(p = 0.72)、通气支持时间(p = 0.62)和菌血症(p = 0.68)之间没有明显关联。结论烧伤外科文献中有关肥胖悖论的新证据并不一致。我们认为,烧伤管理方面的差异(包括对重度烧伤患者的姑息治疗)导致了这些发现。
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引用次数: 0
Single-stage eyebrow reconstruction with a double opposing forehead flap: a case report 使用双对位前额皮瓣进行单阶段眉毛重建:病例报告
Pub Date : 2024-06-04 DOI: 10.34239/ajops.89259
B. Sacks, Elizabeth Concannon, Michael Findlay
The authors describe an alternative option for reconstructing an eyebrow defect following excision of a squamous cell carcinoma using a single-stage, double opposing forehead flap.
作者描述了在鳞状细胞癌切除术后使用单段双对位前额皮瓣重建眉毛缺损的另一种选择。
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引用次数: 0
‘The left behind syndrome’—surgical equipment errors in plastic surgery 遗落综合症"--整形外科中的手术设备错误
Pub Date : 2024-05-21 DOI: 10.34239/ajops.115366
David G Pennington
The author discusses surgical items accidentally left behind in patients after plastic surgery, things that increase the risk of this happening and ways to reduce the risk.
作者讨论了整形手术后意外遗留在患者体内的手术物品、增加这种情况发生风险的因素以及降低风险的方法。
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引用次数: 0
Art, pharmacy and history of skin marking and surgical inks in plastic surgery 整形外科皮肤标记和手术墨水的艺术、药学和历史
Pub Date : 2024-04-09 DOI: 10.34239/ajops.88850
Tzong-Yang Pan, Irene Heng, Brian Sommerlad, Nicola R Dean
Plastic surgeons can be distinguished in pre-planning much of their surgery by drawing on the skin. The history of marking the body with ink in plastic surgery goes back to the 1400s. The Sommerlad pen was originally developed at the London Hospital in the 1970s. Sommerlad pens and Bonney’s blue ink allow for a consistent weight of the pen in hand, a reliable source of ink, and an ability to vary the thickness of the line drawn. There has been a suspicion that gentian violet, a component of Bonney’s blue ink, is a carcinogen, resulting in supply problems. Animal models have demonstrated the carcinogenic properties of gentian violet, but evidence to support the carcinogenic potential of gentian violet in humans is sparse. In the surgical setting, we must adhere to using published and described ink formulas. Proprietary formulations lack standardisation, and the compounds used are not always disclosed. The concerning findings of in-vitro and animal models are a valuable addition to our knowledge about these compounds; however, to over-extrapolate and restrict its use on humans as a topical skin marker takes away an important component of a plastic surgeon’s armamentarium.
整形外科医生通过在皮肤上作画来预先规划许多手术,可谓独树一帜。在整形手术中用墨水在身体上做标记的历史可以追溯到 1400 年代。Sommerlad 笔最初是 20 世纪 70 年代在伦敦医院开发的。Sommerlad 笔和邦尼的蓝色墨水可以使手中的笔重量一致,墨水来源可靠,并能改变所画线条的粗细。有人怀疑邦尼蓝墨水的成分龙胆紫是一种致癌物质,从而导致供应问题。动物模型已证明龙胆紫具有致癌特性,但支持龙胆紫对人类具有致癌可能性的证据却很少。在手术环境中,我们必须坚持使用已公布和描述的油墨配方。专有配方缺乏标准化,所使用的化合物也并不总是公开。体外和动物模型的相关研究结果为我们了解这些化合物提供了宝贵的资料;但是,如果过度推断并限制其在人体中作为局部皮肤标记物使用,就会使整形外科医生的武器装备失去一个重要的组成部分。
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引用次数: 0
Update on gender-affirming surgery 性别确认手术的最新情况
Pub Date : 2024-04-09 DOI: 10.34239/ajops.92498
William Blake
William Blake looks at advances in the provision of gender-affirming surgery and how plastic surgeons in Australia can respond to the need for better surgical care for gender-diverse people.
威廉-布莱克(William Blake)探讨了在提供性别确认手术方面取得的进展,以及澳大利亚整形外科医生如何满足不同性别人群对更好手术护理的需求。
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引用次数: 0
"Breast implant-associated anaplastic large cell lymphoma diagnosis six months post breast reconstruction: a case report" "乳房重建后六个月诊断出乳房植入物相关性变性大细胞淋巴瘤:病例报告"
Pub Date : 2024-04-09 DOI: 10.34239/ajops.88486
Teagan Fink, Siddhartha Deb, David Clouston, Michael Weymouth, Chantel Thornton, A. Chakrabarti
The authors report the earliest time frame (six and a half months) between exposure to textured breast implant and the development of breast implant-associated anaplastic large cell lymphoma.
作者报告了接触纹理乳房植入物与患乳房植入物相关性无性大细胞淋巴瘤之间的最早时间间隔(6 个半月)。
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引用次数: 0
期刊
Australasian Journal of Plastic Surgery
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