Online versus non-standard face to face preoperative assessment: Cost effectiveness

ObjectivesWe evaluate the efficiency of an online preoperative assessment service that allows early triage of patients that require further assessment in advance of the clinic and reduces the number of preoperative tests.MethodsWe developed a preoperative assessment process where the anesthesiologist collected on-line information without the physical attendance of the patient that included the patient's health history and all the preoperative tests performed in the primary and hospital care. Once confirmed this information by a telephone call, the anesthesiologist identified those patients that required further face to face assessment and limited the number of preoperative tests according to the complexity of the operative procedure and the anesthetic risk. In some procedures trained nursery collected on – line information and in certain cases consulted the anesthesiologist. We compared a cohort of preoperative patients before (2008) and after (2010) developing this online preoperative assessment process. We determined in both periods the number of face to face preoperative assessments and preoperative tests performed. Finally, we compared the cancellation rate in both periods.Results5112 elective surgical procedures in 2008 and 6867 elective surgical procedures in 2010 were assessed. In 2010, face to face preoperative assessments dropped to 21%, the number of laboratory tests 15%, the number of electrocardiograms 6% and the number of chest x-rays 1%. The cancellations rate didn’t differ between 2008 (2,3%) and 2010 (1.75%).ConclusionsThis preoperative process optimizes the resources reducing the number of face to face preoperative assessments and preoperative tests without increasing the cancellations rate.     

Flash burns to the face

A characteristic 'crow's foot' pattern is seen around the eye in many flash burns. The protective blink reflex underlies this, and the injury is due to convected rather than radiant energy.     

3D-printed face protective shield in interventional radiology: Evaluation of an immediate solution in the era of COVID-19 pandemic

PurposeThe purpose of this study was to report the clinical evaluation of a 3D-printed protective face shield designed to protect interventional radiologists from droplet transmission of the SARS-Cov-2.Materials and methodsA protective face shield consisting in a standard transparent polymerizing vinyl chloride (PVC) sheet was built using commercially available 3D printers. The 3D-printed face shield was evaluated in 31 interventional procedures in terms of ability to perform the assigned intervention as usual, quality of visual comfort and tolerance using a Likert scale (from 1, as very good to 5, as extremely poor).ResultsThe mean rating for ability to perform the assigned intervention as usual was 1.7 ± 0.8 (SD) (range: 1–4). The mean visual tolerance rating was 1.6 ± 0.7 (SD) (range: 1–4). The mean tolerability rating was 1.4 ± 0.7 (SD) (range: 1–3).ConclusionThe 3D-printed protective face shield is well accepted in various interventions. It may become an additional option for protection of interventional radiologists.     

Chain saw injuries to the face

Chain saws may produce devastating facial injuries when the blade kicks back after striking a hard object. A review of experience with 12 male patients indicates that in addition to extensive ragged lacerations of skin and soft tissues, bone and teeth are frequently fractured. Eye injuries are rare, but the eyelids may be extensively damaged. Management includes debridement and exploration of the wounds, repair of soft tissues, removal of fractured roots, and application of arch bars if the jaw is fractured.     

脊柱单侧结构疾患对脊柱稳定性的影响(附42例报告)

[目的]探讨脊柱单侧结构疾患对脊柱稳定性的影响特点及治疗方法；分析比较传统三柱理论及新提出的三棱柱理论的特点。[方法]通过2001～2006年本院收治保存资料完整的脊柱单侧结构疾患病例42例，其中单关节突疾患21例，单侧椎板疾患10例，单侧椎弓根疾患7例，单侧多结构疾患4例。经过保守治疗11例，单节段单侧内固定4例，单节段双侧内固定手术治疗27例。分析从而揭示脊柱三棱柱结构的本质。[结果]42例病例完全得到随访，平均随访28个月。按时述山等标准评定优31例，良8例，可3例，优良率达93％以上。[结论]脊柱单侧结构疾患可致脊柱椎体旋转或侧弯，而很少导致脊柱滑脱；脊柱是一个由多个三角形叠加的三棱柱，其任何一个柱或角遭到破坏均影响其稳定性。     

Time to face the healthcare challenge

The Affordable Care Act is upon us. The success, extent, and quality of the resulting care is not fully under our control. That is surely an understatement. Healthcare is one-fifth of the United States' Gross National Product, and it is no longer ours to control. Nonetheless, we have all taken an oath, the Hippocratic Oath, and in 2012, that oath includes being advocates for our patients and helping insure that we, as a nation, "do no harm."     

The Helsinki approach to face transplantation

Aim

We herein describe the establishment of the Helsinki Vascularized Composite Allotransplantation (VCA) program and its execution in the first two face transplant cases.

Free dermal fat flaps to the face

Patients with extensive facial asymmetry continue to be a challenge in reconstructive surgery. Surgical techniques using microvascular anastomoses and free flap transfers can now be applied in the management of patients with such conditions as Romberg disease, postirradiation hypoplasia of the face, and Goldenhar syndrome, and in patients with bronchial arch developmental defects. Four patients are presented in this paper to demonstrate the use of free dermal fat in reconstruction of facial asymmetry. One patient with a moderate facial defect was treated with a free dermal fat graft, and the other 3, who had more extensive defects, were treated with deepithelialized free dermal fat flaps using direct microvascular anastomoses between the donor and recipient vessels. The groin was the donor area in each case. Results appear to indicate that free dermal fat flaps are useful in reconstructive procedures for patients with extensive facial defects.     

面部软组织外伤急症的整形外科修复

目的 探讨利用整形外科技术对面部软组织外伤急症修复的临床效果.方法 以微创为原则,修整伤口,精细缝合,并根据软组织的缺损情况,采用皮瓣移植进行Ⅰ、Ⅱ期修复.自2005年1月至2008年1月,对786例面部软组织外伤的急症患者进行修复.结果 术后创口无感染、血肿、皮瓣坏死出现.Ⅰ期修复者692例,Ⅱ期修复者94例.随访其中的461患者3～6个月,术区无明显瘢痕增生,面部器官无牵拉变形,效果良好.结论 应用整形外科技术修复面部软组织外伤急症,患者术后恢复较快,畸形发生较少,是修复面部软组织外伤急症的较好方法.