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At least 181 records · Page 10Linked to original sources
PubMed2007

Dynamics of hospital-based plastic surgery.

BACKGROUND: Legislative regulations, decreasing reimbursements for office procedures, and malpractice premiums have transformed plastic surgery from an office-based specialty into a hospital-based one. Simultaneously, hospital economics has altered, wherein the "business model" has all but subsumed the old "medical care" model. Integration between plastic surgeons and the new hospital structure has been difficult for both. Limited understanding of the financial dynamics of hospital-based practices, unfamiliarity with the administrative processes, and resistance to accept and assimilate changes by both sides pose hurdles, in some situations even forcing plastic surgeons out of hospital settings. METHODS: Using well-defined financial terminology, changing national development in health care policy, and hospital-based administrative strategies as a backdrop, this study finds common ground for the plastic surgery specialty to coapt with the hospital. RESULTS: Key missing elements in the interaction between plastic surgeons and hospital administrations and ways of integrating these components are identified. To do so effectively, plastic surgeons must first understand the basic tenets of management that drive hospital administrators, participate at every level they can in guiding these processes, and assume leadership roles that will ultimately dictate the way they work and conduct their professional lives. CONCLUSIONS: It is critical that plastic surgeons engage in important processes that govern the economics of hospital-based health care delivery. This commitment will also ensure that all three groups (the patients, physicians, and hospital administrators) achieve a degree of satisfaction. The message to plastic surgeons is clear: be proactive and lead a campaign of change.

Financial Management, Hospital↗
PubMed2002

The prevention of emesis in plastic surgery: a randomized, prospective study.

Perhaps the most unpleasant experience following outpatient plastic surgery procedures is postoperative nausea and vomiting. Postoperative nausea and vomiting often results in delayed recovery time and unintended admission, and it can be a contributing factor to the formation of hematoma following rhytidectomy. Ondansetron (Zofran) has proven benefit in preventing postoperative nausea and vomiting if given before general anesthesia in a variety of surgical procedures. Its utility in cases performed under conscious sedation has not been determined. The purpose of this study was (1) to test the ability of prophylactic ondansetron to prevent postoperative nausea and vomiting in plastic surgery cases performed under conscious sedation, and (2) to determine relative risk factors for postoperative nausea and vomiting and a selection policy for the administration of antiemetic prophylaxis. This was a prospective, randomized, double-blind study. One hundred twenty patients were enrolled after giving informed consent. Patients received a single dose of either placebo or ondansetron (4 mg intravenously) before administration of sedation. Sedation administration followed a standardized institutional protocol, using midazolam and fentanyl. Data were recorded from a series of three questionnaires: preoperatively, immediately postoperatively, and at the time of the first office return. Data were confirmed by means of telephone interview, chart analysis, and nursing documentation. Multivariate analysis was conducted. Nausea and emesis occurred with an overall frequency of 33 percent and 22 percent, respectively. Postoperative nausea and vomiting was associated with statistically longer recovery periods. The incidence of emesis was statistically higher among women, among those undergoing facial rejuvenation, and among those with a history of opioid-induced emesis or postoperative nausea and vomiting following a previous operation (p < 0.05). The incidence of postoperative nausea and vomiting paralleled increases in case duration; the incidence of emesis was zero in cases less than 90 minutes in duration. Ondansetron significantly reduced the incidence of emesis overall (placebo, 30 percent; ondansetron, 13 percent; p < 0.05). Postoperative perception of nausea was significantly lower among those who had received ondansetron (p < 0.05). These results confirm the efficacy of ondansetron for the prevention of postoperative nausea and vomiting in plastic surgery cases under conscious sedation. In those who are at increased risk, prophylaxis should be considered. Such risks include female gender, facial rejuvenation procedures, and a patient history of opioid-induced emesis or postoperative nausea and vomiting following a prior operation. The zero incidence of emesis in cases less than 90 minutes does not support the routine use of prophylaxis in such cases. Patient satisfaction in plastic surgery is derived from the overall subjective experience of the event as much as by the final result. By remaining attentive to patient concerns and optimizing perioperative care, we can improve the subjective experience for our patients.

Analgesics, Opioid↗
PubMed2004

Implant plastic surgery: a review and rationale.

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.

Alveoloplasty↗
PubMed1999

Permanent lip augmentation with serial fat grafting.

A simple technique for lip augmentation with autologous fat is presented. Local anesthesia is injected into those areas used for fat harvesting and the perioral areas that are to receive the grafts. The fat is taken with a large needle and syringe, washed over meshed gauze, placed into the syringe, and injected into the lip tissue. Multiple passes with a small needle deposit the strained fat in horizontal tunnels within the lips. Subsequent injections are performed at a minimum of 3 months. Lip swelling is short lived and permanent lip augmentation occurs when patients undergo two to three grafting procedures.

Adipose Tissue↗
PubMed2000

Techniques for reconstruction of perialar and perialar-nasal ala combined defects.

BACKGROUND: The nasal ala and perialar areas involve junctions with the nose, cheeks, and lips. Following Mohs surgery, defects in this area often extend across one or more creases or folds, thus requiring repair of more than one reconstructive subunit. OBJECTIVE: Our goal is to present various reconstructive techniques required to obtain aesthetic results. METHODS: Defects and reconstructions will be illustrated to demonstrate techniques and results. Emphasis will be on selection of techniques and documentation of results. RESULTS: Examples include various flap procedures (advancement, rotation, pedicle, interpolation, transposition), full-thickness and composite grafting, second intention healing, and combinations thereof. CONCLUSIONS: Thoughtful application of the various techniques will help to maximally camouflage scars and avoid maneuvers which would result in bridging and/or blunting of creases and folds.

Dermatologic Surgical Procedures↗