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Jeffrey E Janis

Publications and source records attributed to Jeffrey E Janis.

At least 19 recordsLinked to original sources
PubMed2006

Patient safety in the office-based setting.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Discern the importance of the physician's office administrative capacity. 2. Recognize the necessity of a system for quality assessment. 3. Assess which procedures are safe in the office-based setting. 4. Know the basic steps to properly evaluate patients for office-based plastic surgery. BACKGROUND: At least 44,000 Americans die annually as a result of preventable medical errors. Medical mistakes are the eighth leading cause of death in the United States, costing between $54.6 billion and $79 billion, or 6 percent of total annual national health care expenditures. Office-based procedures comprise a 10-fold increase in risk for serious injury or death as compared with an ambulatory surgical facility. METHODS: This article reviews the literature on office-based patient safety issues. It places special emphasis on the statements and advisories published by the American Society of Plastic Surgeons' convened Task Force on Patient Safety in Office-Based Settings. This article stresses areas of increased patient safety concern, such as deep vein thrombosis prophylaxis and liposuction surgery. RESULTS: The article divides patient safety in health care delivery into three broad categories. First, patient safety starts with emphasis at the administrative level. The physician or independent governing body must develop a system of quality assessment that functions to minimize preventable errors and report outcomes and errors. Second, the clinical aspects of patient safety require that the physician evaluate whether the procedure(s) and the patient are proper for the office setting. Finally, this article gives special attention to liposuction, the most frequently performed office-based plastic surgery procedure. CONCLUSIONS: Patient safety must be every physician's highest priority, as reflected in the Hippocratic Oath: primum non nocere ("first, do no harm"). In the office setting, this priority requires both administrative and clinical emphasis. The physician who gives the healing touch of quality care must always have patient safety as the foremost priority.

Ambulatory Surgical Procedures↗
PubMed2006

Wound healing: an overview.

Understanding wound healing today involves much more than simply stating that there are three phases: inflammation, proliferation, and maturation. Wound healing is a complex series of reactions and interactions among cells and "mediators." Each year, new mediators are discovered and our understanding of inflammatory mediators and cellular interactions grows. This article will attempt to provide a concise overview on wound healing and wound management.

Cell Division↗
PubMed2006

A brief history of wound care.

Since the caveman, man has been tending to his wounds. Wound care evolved from magical incantations, potions, and ointments, to a systematic text of wound care and surgery from Hippocrates and Celsus. These advances were lost after the fall of the Roman Empire. In Europe, the Middle Ages were a regression of wound care back to potions and charms. It was'nt until the time of large armies using muskets and cannons that surgical wound care emerged again. This article will briefly highlight major milestones in wound care.

Animals↗
PubMed2006

The basic science of wound healing.

Understanding wound healing today involves much more than simply stating that there are three phases: "inflammation, proliferation, and maturation." Wound healing is a complex series of reactions and interactions among cells and "mediators." Each year, new mediators are discovered and our understanding of inflammatory mediators and cellular interactions grows. This article will attempt to provide a concise report of the current literature on wound healing by first reviewing the phases of wound healing followed by "the players" of wound healing: inflammatory mediators (cytokines, growth factors, proteases, eicosanoids, kinins, and more), nitric oxide, and the cellular elements. The discussion will end with a pictorial essay summarizing the wound-healing process.

Cell Proliferation↗
PubMed2006

Clinical approach to wounds: débridement and wound bed preparation including the use of dressings and wound-healing adjuvants.

This is a clinical review of current techniques in wound bed preparation found to be effective in assisting the wound-healing process. The process begins with the identification of a correct diagnosis of the wound's etiology and continues with optimizing the patient's medical condition, including blood flow to the wound site. Débridement as the basis of most wound-healing strategies is then emphasized. Various débridement techniques, including surgery, topical agents, and biosurgery, are thoroughly discussed and illustrated. Wound dressings, including the use of negative pressure wound therapy, are then reviewed. To properly determine the timing of advance therapeutic intervention, the wound-healing progress needs to be monitored carefully with weekly measurements. A reduction in wound area of 10 to 15 percent per week represents normal healing and does not mandate a change in the current wound-healing strategy. However, if this level of wound area reduction is not met consistently on a weekly basis, then alternative healing interventions should be considered. There is a growing body of evidence that can provide guidance on the appropriate use of such adjuvants in the problem wound. Several adjuvants are discussed, including growth factor, bioengineered tissues, and hyperbaric medicine.

Acute Disease↗
PubMed2006

An algorithmic approach to upper arm contouring.

There has been a renewed interest in upper arm contouring given the recent advances and subsequent patient interest in weight loss. Patients undergoing bariatric surgery are often left with a significant amount of redundant skin and laxity of their upper extremity. Some patients within this group have excess fat in their upper arms with relatively good skin tone, while others have a paucity of excess fat with a significant amount of redundant skin. The optimal treatment for each patient can vary. A clinical algorithm is presented that is designed to select the best method for upper arm contouring based on the aesthetic analysis of the upper arm. Case examples are provided demonstrating results that were obtained by following this algorithm.

Adipose Tissue↗
PubMed2005

Reconstruction of acquired scalp defects: an algorithmic approach.

LEARNING OBJECTIVES: After studying this article, the participant should: 1. Understand scalp anatomy, hair physiology, and skin viscoelastic properties as they relate to scalp reconstruction. 2. Understand the principles that allow for aesthetic reconstruction of scalp defects. 3. Understand the use of local tissue rearrangement for reconstruction of specific areas of the scalp. 4. Understand the use of tissue expansion and free tissue transfer for scalp reconstruction. BACKGROUND: Reconstruction of scalp defects is required for acute trauma, tumor extirpation, radiation necrosis, and the repair of traumatic alopecia or cosmetically displeasing scars. METHODS: The proper choice of a reconstructive technique is affected by several factors-the size and location of the defect, the presence or absence of periosteum, the quality of surrounding scalp tissue, the presence or absence of hair, location of the hairline, and patient comorbidities. Successful reconstruction of these defects requires a detailed knowledge of scalp anatomy, hair physiology, skin biomechanics, and the variety of possible local tissue rearrangements. In nearly total defects, local tissues may be inadequate and tissue expansion or free tissue transfer may be the only alternatives. RESULTS: Plastic surgeons are now able to obtain coverage over the calvaria after the most devastating of defects; however, the challenge to the reconstructive surgeon today is to do so with excellent cosmetic results. Cosmetic scalp reconstruction requires restoration and preservation of normal hair patterns and hair lines. CONCLUSIONS: Successful reconstruction of the scalp requires careful preoperative planning and precise intraoperative execution. Detailed knowledge of scalp anatomy, skin biomechanics, hair physiology, and the variety of available local tissue rearrangements allows for excellent aesthetic reconstruction.

Algorithms↗
PubMed2005

Otoplasty.

BACKGROUND: Auricular deformities, specifically, prominent ears, are relatively frequent. Although the physiologic consequences are negligible, the aesthetic and psychological effects on the patient can be substantial. METHODS: Otoplasty techniques are used to correct many auricular deformities, including the prominent ear, the constricted ear, Stahl's deformity, and cryptotia. Various treatments and techniques have been developed for the correction of these deformities, including methods that excise, bend, suture, scratch, or reposition the auricular cartilage. RESULTS: The multitude of different approaches indicates that there is not one clearly definitive technique for correcting these problems. CONCLUSIONS: This article reviews the history of otoplasty, its anatomical basis and a method for evaluation, techniques for the correction of the deformity, and potential complications of the procedure.

Adolescent↗
PubMed2005

The lesser and third occipital nerves and migraine headaches.

BACKGROUND: Reports of a correlation between relief of migraine headaches and resection of corrugator muscles or injection of botulinum A toxin have renewed interest in finding the cause of migraine headaches and identifying the trigger sites. Four trigger sites have been described. One of these is along the course of the greater occipital nerve. Recent anatomical studies of this nerve have defined its location with respect to external landmarks, leading to new studies with gratifying results. There is a subset of patients who undergo chemodenervation or surgical release of the greater occipital nerve and note improvement or elimination of the symptoms along the greater occipital nerve course but who experience an emergence of migraine headache symptoms laterally. The authors propose the lesser occipital nerve as the source of pain in those who experience headaches laterally and involvement of the third occipital nerve in those who notice residual symptoms in the midportion of the occipital region. METHODS: To test this hypothesis anatomically, 20 cadaver heads were dissected to trace the course of the lesser occipital nerve and third occipital nerve and define the location of these nerves with respect to external landmarks. The midline and a line drawn between the inferiormost points of the external auditory canals were used to obtain standardized measurements of these nerves. RESULTS: The location of emergence of the lesser occipital nerve was determined to be an area centered 65.4 +/- 11.6 mm from midline and 53.3 +/- 15.6 mm below the line between the external auditory canals. The third occipital nerve was found 13.2 +/- 5.3 mm from midline and 62.0 +/- 20.0 mm down from the line between the two external auditory canals. CONCLUSIONS: This information can be used to conduct clinical trials of chemodenervation of these nerves in an attempt to eliminate migraine symptoms in the subset of patients who continue to experience residual symptoms after surgical release of the greater occipital nerve.

Botulinum Toxins, Type A↗
PubMed2004

The anatomy of the greater occipital nerve: implications for the etiology of migraine headaches.

An interest in pursuing new theories of the underlying etiology of migraine headaches has been sparked by previously published reports of an association between amelioration of migraine headache symptoms and corrugator resection during endoscopic brow lift. This theory has further been reinforced by recent publications documenting improvement in migraine headaches following injection of botulinum A toxin. There are thought to be four major "trigger points" along the course of several peripheral nerves that may cause migraine headaches. Among these peripheral nerves is the greater occipital nerve. For this reason, the authors have undertaken an anatomic study of this nerve to determine its usual course, potential anatomic variations, and possible points of potential entrapment or compression. The results of this anatomic study have enhanced further development of techniques designed to address these points of entrapment/compression and potentially lead to relief of migraine headaches caused by this mechanism. Twenty cadaver heads from patients with an unknown history of migraine headaches were dissected to trace the normal course of the greater occipital nerve from the semispinalis muscle penetration to the superior nuchal line. Standardized measurements were performed on 14 specimens to determine the location of the emergence of the nerve using the midline and occipital protuberance as landmarks. On the basis of this information, the location of emergence was determined to be at a point centered approximately 3 cm below the occipital protuberance and 1.5 cm lateral to the midline. This location can, in turn, be used to guide the practitioner performing chemodenervation of the semispinalis capitis muscle in an attempt to provide migraine symptom relief.

Humans↗
PubMed2004

Component dorsal hump reduction: the importance of maintaining dorsal aesthetic lines in rhinoplasty.

Dorsal hump reduction can create both functional and aesthetic problems if performed incorrectly. Component dorsal hump reduction allows a graduated approach to the correction of the nasal dorsum by emphasizing the integrity of the upper lateral cartilages when performing dorsal reduction. Use of this approach can minimize the need for spreader grafts in primary rhinoplasty patients. Possible untoward sequelae of dorsal hump reduction include long-term dorsal irregularities caused by uneven resection or overresection or underresection of the osseocartilaginous hump irregularity; the inverted-V deformity; and excessive narrowing of the midvault. The component dorsal hump reduction technique is a five-step method: (1) separation of the upper lateral cartilages from the septum, (2) incremental reduction of the septum proper, (3) dorsal bony reduction, (4) verification by palpation, and (5) final modifications (spreader grafts, suturing techniques, osteotomies). A graduated approach is described that offers control and precision at each interval. Fundamental to the final outcome is the protection and formation of strong dorsal aesthetic lines that define the appearance of the dorsum on frontal view. Furthermore, preservation of the transverse portions of the upper lateral cartilages is essential to maintain patency of the internal nasal valve, maintain the shape of the dorsal aesthetic lines, and avoid the inverted-V deformity. Finally, if needed, spreader grafts are enormously adaptable and can be customized for any deformity (unilateral or bilateral, visible or invisible) to handle functional or aesthetic problems.

Adult↗
PubMed2004

Rhinoplasty with advancing age.

Rhinoplasty in the aging patient poses a unique set of challenges to the plastic surgeon. Aging patients usually have different expectations and motivations than their younger counterparts; therefore, open communication and frank discussions are paramount to define realistic goals. Anatomically, changes in skin quality, cartilage characteristics, underlying bony framework, and the nasal airways mandate special considerations to optimize the functional and aesthetic results. This review will present a practical approach to the management of the nose in the aging patient.

Aged↗
PubMed2003

Male rhinoplasty.

Rhinoplasty is one of the most complex and challenging operations in plastic surgery. This complexity is increased among male patients, because male patients tend to have relatively nonspecific complaints, are typically more demanding, and are regarded as being much less attentive during consultations. It is critical for the surgeon to verify that the male patient has realistic goals before he undergoes an operation, and the surgeon must confirm that the male patient has heard and understood all of the risks, benefits, and options. It is essential that masculine features be preserved for male rhinoplasty patients. Excessive dorsal reduction or tip refinement produces unsatisfactory results. A comprehensive discussion of proper evaluation of the male nose, surgical planning, intraoperative techniques, and postoperative treatment is presented. These tools should allow plastic surgeons to produce a balanced harmonious nose in relation to the rest of the face.

Adult↗
PubMed2003

Subciliary versus subtarsal approaches to orbitozygomatic fractures.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the anatomic differences in the subciliary versus the subtarsal approach. 2. Discuss the difference between the "skin-only" and the "skin-muscle flap" variations of the subciliary approach. 3. Discuss the potential complications of both approaches. 4. Discuss the advantages of the subtarsal approach versus the subciliary approach. Many incisions have been described for approaches to orbitozygomatic fractures, the most frequently used being the subciliary incision with its modifications, the subtarsal incision, and the transconjunctival incision with or without lateral canthotomy. Each of these approaches has its advantages and disadvantages that may make it more or less appealing to use depending on the patient's age and severity of fracture. A balance must be struck between adequate exposure and acceptable cosmetic result. This article reviews the literature with particular respect to the transcutaneous approaches of subciliary versus subtarsal techniques in the treatment of orbitozygomatic fractures.

Adult↗