Model Developed to Define and Report Medical Errors

The American Association of Accreditation of Ambulatory Surgery Facilities Inc (AAAASF), the Accreditation Association for Ambulatory Health Care Inc (AAAHC), and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have collaborated to develop a model to define and report medical errors in office-based surgery (OBS). Previously, there has not been a consensus as to what constitutes an OBS medical error or the critical data elements that should be reported and analyzed.

“The move toward state-level mandatory adverse-event reporting requirements and quality improvement is an important trend in health care,” says Francis DiPlacido, DMD, FACD, AAAHC president. “Currently, there are about 13 states that have mandatory reporting requirements for OBS facilities, but there is no consistency in the definitions of adverse reportable events. Our agreement is intended to help legislators or regulators in setting high standards for quality health care in OBS facilities.”

Health care accreditation agencies inspect and evaluate OBS facilities to ensure that they meet standards of excellence and verifiable quality. Accreditation involves evaluating an OBS facility’s performance in areas that affect patient health and safety. By achieving accreditation, an OBS facility commits to following an established set of standards, which provides safe, high-quality care.

In July 2005, President Bush signed the Patient Safety and Quality Im­prove­ment Act into law, establishing a confidential, voluntary reporting system in which physicians and other health care providers could submit information on errors to patient-safety organizations without fear of lawsuits or punishment.

“Patient safety is of paramount importance to all physicians,” says Thomas R. Russell, MD, FACS, executive director of the American College of Surgeons. “That is why we at the college and the leadership of the American Society of Plastic Surgeons felt it imperative to help facilitate this important collaboration between the accrediting agencies.”

Tips for Winterizing Skin

Winter is here, and so is the dry, itchy skin season. Winter can wreak havoc on patients’ skin, causing numerous problems. Fortunately, with a properly followed treatment program, patients can have better-looking and better-feeling skin.

Charles E. Crutchfield III, MD, of Eagan, Minn, offers four simple principles that patients can follow to obtain healthy-looking skin this winter: cleanse, moisturize, protect, and correct.

According to Crutchfield, it is important to cleanse the face with products that contain lotion to replace the moisture lost during cleansing and that do not contain detergents that remove natural oil from the skin.

 Moisturizing the skin is also important, says Crutchfield, especially during winter, when humidity is low. The best time to apply moisturizer is right after bathing. It is important to gently pat-dry the face with a cotton towel and liberally apply the moisturizing lotion. Some moisturizers he recommends contain sesame oil, oatmeal, and alpha-hydroxy acids.

To protect the skin, Crutchfield recommends using a sunscreen that has a sun-protection factor of 15 or higher as well as UV-A protection. The sunscreen must be applied 30 minutes before UV exposure and every 30 to 60 minutes thereafter.

Crutchfield’s final principle for obtaining beautiful-looking skin is to use lotions to correct and reverse the signs of aging. Antioxidants are a broad category of substances that quench the free radicals produced in normal skin processes. Corrective lotions that contain alpha-hyroxy acids perform this function.

Hypertension and Male Plastic Surgery

According to a report published in the December 2005 issue of Plastic and Reconstructive Surgery, the official journal of the American Society of Plastic Surgeons (ASPS), men are twice as likely as women to develop hema­tomas (abnormal, localized collections of clotted blood) after surgery, especially if they have hypertension.

“Blood vessels are like plumbing,” says Daniel Baker, MD, an ASPSmember and the study’s author. “If the pressure is too high in your water pipes, they are going to start leaking. It is the same in people. After surgery, if a person’s blood pressure is too high, it will cause the little vessels in that area to bleed.”

Men are more likely to suffer from hematomas than women after a facelift due to skin differences. Men have thicker skin than women and therefore more blood vessels, which require more blood flow.

In the study, the incidence of he­matomas in male patients dropped from 8.7% to 3.97% after all patients followed a strict blood-pressure-control regimen.

To decrease the risk of hematomas, patients should undergo a careful preoperative evaluation by their plastic surgeon, as well as manage and stabilize their blood pressure. Patients can further help decrease the risk of hematoma by discontinuing all medications that can cause bleeding, including aspirin and other nonsteriodal anti-inflammatory drugs, before surgery.

A New Procedure for Skin Rejuvenation

A new skin-rejuvenation procedure, plasma skin regeneration, uses plasma energy to regenerate skin. The US Food and Drug Admini­stration has approved Portrait® PSR3 by Rhytec to treat facial rhytides, superficial skin lesions, and actinic keratoses for full-face and regional resurfacing.

Plasma skin regeneration is a minimally invasive, nonablative rejuvenation procedure that may be performed in the office. Most treatments are done with topical lidocaine gel with or without pretreatment sedatives. Regional blocks and intravenoussedation are an option, although neither is usually needed.

During the procedure, a plasma is generated inside a handpiece by imparting ultrahigh-frequency energy to a flow of nitrogen gas. The resulting highly energized nitrogen molecules are delivered in milliseconds. Because the nitrogen plasma has a very low thermal time constant, it releases its thermal energy rapidly so the skin is not broken or vaporized upon treatment.

Plasma skin regeneration provides rapid healing with minimal pain and downtime, producing mild redness for a few days.

Although there are no published data yet, the initial results have been promising.

Plastic Surgery Is Popular Among Minorities

According to the American Society for Aesthetic Plastic Surgery (ASAPS), the number of aesthetic procedures performed on minorities increased from 14% to 20% between 2000 and 2004. Hispanics topped the list with 8.5% of the total, followed by African-Americans at 6.2%, Asians at 4.6%, and other non-Caucasians at 1.1%.

“Many are realizing that plastic surgery can be done without feeling like you’re trying to change your ethnicity,” according to Julius Few, MD, FACS, assistant professor at the Northwestern University Feinberg School of Medicine in Chicago. “New procedures and specific training in treating ethnic populations have opened new avenues for patients who previously were afraid to try many procedures.”

According to Renato Saltz, MD, of Salt Lake City, expertise in treating skin of color involves more than knowing how a certain laser or injectable might affect the patient. Saltz believes that one size does not fit all. “South American women typically want smaller breasts and larger buttocks than the average white American female,” says Saltz. “Being aware of cultural differences is more than just speaking the language; it’s about understanding how patients want to enhance their natural ethnic beauty.”

With increased awareness of ethnic concerns and new procedures, people from all demographic groups are beginning to consider changing their noses, lips, and eyes without losing connection to their heritage.

Volunteer Overseas From Your Desk

Are you too busy to leave your practice to volunteer overseas? If so, Medicorps offers the opportunity to join its Internet Relief Net­work so you can volunteer from your desk.

In the Internet Relief Network, foreign physicians request advice on complicated problem cases by email with digital images attached. The advising physician can follow the case directly with the requestor until a resolution is achieved.

Medicorps is currently in the second phase of its pilot project in Cambodia, where US residents and students rotate as facilitators to make the exchange of information smoother and more productive. Once you are enrolled in this program, your skills can be transferred to partners in poorer countries.

For additional information, contact Medicorps, 1062 Alewa Dr, Honolulu, HI 96817; (808) 988-4191;

Hyaluronidase Eliminates Skin Deformities

A study conducted by A. John Vartanian, MD, a board-certified facial plastic surgeon in Glendale, Calif, has found that the enzyme hyal­uro­nidase eliminates undesirable skin deformities that result from the misinjection of hy­aluronic acid.

“Lumps and bumps resulting from overinjected hyaluronic acid can be disturbing to pa­tients, especially since they may last for a considerable period of time,” Vartanian says.

In the study, published in the August 2005 issue of Archives of Facial Plastic Surgery, Vartanian enlisted a group of patient volunteers to be injected in the forearm with hyaluronic acid. After the injection, each patient’s bump was measured and documented on a scale of 0 to 4 (0 representing no traces of any injected material, and 4 representing a raised injection area).

Three to 5 days following the initial injection of the hyaluronic acid, each patient was injected in the same area with hyaluronidase solution or saline solution.

Vartanian discovered that the injection of hyaluronidase solution dramatically decreased the areas of skin that were raised. After 14 days, the raised areas had completely disappeared.

“The results of this study are very encouraging to patients who don’t want to wait 6 to 9 months for their lumps and bumps to finally dissipate,” Vartanian says. “These patients can now experience relief within a few days of their original injection and go home much happier.”

Farewell to Flabby Arms

A new approach to armlift surgery—the mini, or modified, armlift, developed by Robert Whitfield, MD, from Milwaukee—promises to deliver the tight, toned arms that women have dreamed of for years.

Whitfield says the procedure leaves patients with more youthful-looking arms. “It’s just a nice, smooth transition from the elbow to the armpit area without any excess skin hanging down,” Whitfield says.

During the 90-minute surgery, extra fat and other tissue from flabby arms are removed and the rest of the skin is lifted up toward the underarm.

According to Whitfield, the incision made during the procedure is much smaller, and the resulting scar is hardly visible, compared to the traditional armlift.

The best candidates for the mini armlift are patients who are in good shape and have a moderate amount of skin drooping from their upper arms.

Mark Your Calendar

Make plans to attend the Medical Spa Expo & Conference at the Los Angeles Convention Center, February 26–27, 2006. This event is designed for all medical and spa professionals, including dermatologists, plastic surgeons, nurses, naturopaths, estheticians, and spa owners and managers.

The expo exhibits will showcase the latest innovations in the spa and medical spa fields. An educational program, sponsored by the Medical Spa Society, will provide hands-on experiences for practitioners. A networking cocktail re­ception (open to all attendees and exhibitors) will give professionals the opportunity to catch up with old friends, make new connections, and wind down after a day at the event.

To register for the conference, con­tact Diana Press at (800) 363-3631 or [email protected].

Breast Implants Without Scars?

Many women who undergo breast-implant surgery are concerned about  the resulting scars. A new procedure called transumbilical breast augmentation—performed by Victoria Vitale-Lewis, MD, a board-certified plastic surgeon in Mel-bourne, Fla—is revolutionary and virtually scarless. “You always have a scar,” Vitale-Lewis says, “but the scar can be any kind of scar, and it’s the most invisible we could make.”

Transumbilical breast augmentation is a quick, easy procedure in which the implants are inserted through the navel rather than under the breast. Alternatively, the implants can be introduced through the nipple or armpit.

Prior to surgery, all the air is pumped out of the implants. The plastic surgeon then rolls up the implants—like a cigar—and pushes them through the navel and into the chest. The implants are then filled with saline solution to the desired size.

Recovery is quick, but there is a tradeoff: Patients do experience breast and abdominal pain for a few days.

New Technique Helps Patients Recover Faster

According to Jennifer Buck, MD, at the Plastic Surgery Center of Palm Harbor (Fla), a type of massage called “manual lymphatic drainage” releases endorphins to reduce patients’ stress and aid the postsurgical healing process.

“The lymphatic system is the ‘sanitation department’ of the body,” Buck says. “It takes up toxins and moves them out. If it’s backed up, the entire body can suffer.”

The lymphatic system is located throughout the body, including the head, neck, armpits, torso, groin, and legs. Congested lymph pathways can cause soreness, aches, pains, and flu-like symptoms.

Manual lymphatic massage filters out bacteria and toxins and helps unclog the lymph system.

Buck says the massage is not recommended for pregnant women or patients with active infection or other serious conditions.