Annals of plastic surgery
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Annals of plastic surgery · Jun 2015
Increasing value in plagiocephaly care: a time-driven activity-based costing pilot study.
Process management within a health care setting is poorly understood and often leads to an incomplete understanding of the true costs of patient care. Using time-driven activity-based costing methods, we evaluated the high-volume, low-complexity diagnosis of plagiocephaly to increase value within our clinic. ⋯ This pilot study effectively demonstrates the novel use of time-driven activity-based costing in combination with the value equation as a metric for continuous process improvement programs within the health care setting.
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Annals of plastic surgery · Jun 2015
ReviewNerve Transfers in the Upper Extremity: A Practical User's Guide.
Nerve injuries above the elbow are associated with a poor prognosis, even with prompt repair and appropriate rehabilitation. The past 2 decades have seen the development of numerous nerve transfer techniques, by which a denervated peripheral target is reinnervated by a healthy donor nerve. Nerve transfers are indicated in proximal brachial plexus injuries where grafting is not possible or in proximal injuries of peripheral nerves with long reinnervation distances. ⋯ For ulnar intrinsic function, the distal anterior interosseous nerve to ulnar motor branch transfer has yielded excellent functional results. Nerve transfers form a therapeutic triad with traditional tendon transfers and functional motor unit rehabilitation which, when applied appropriately, can yield excellent functional results in complex nerve injuries. Nerve transfers are a powerful yet underused tool for proximal nerve injuries, which offer hope for traditionally discouraging injuries.
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Annals of plastic surgery · Jun 2015
Comparative StudyStuck in a moment: an ex ante analysis of patient complaints in plastic surgery, used to predict malpractice risk profiles, from a large cohort of physicians in the patient advocacy reporting system.
Unsolicited patient complaints (UPCs) serve as a powerful predictor of increased risk of malpractice claims, and reductions in UPCs, through targeted physician interventions, lower incidence of lawsuits and decrease cost of risk management. We analyzed UPCs, verified by trained counselors in patient relations, to determine the malpractice risk of plastic surgeons, compared to dermatologists, all surgeons, and all physicians, from a national patient complaint registry. ⋯ "Reconstructive" plastic surgeons are at increased risk for UPCs, compared to most physicians, especially dermatologists. Because UPCs are a robust proxy for malpractice risk, targeted interventions to decrease patient complaints may improve patient satisfaction and reduce malpractice claims and risk management activity. Monitoring UPCs may permit early identification of high-risk surgeons before malpractice claims accumulate.
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Annals of plastic surgery · Jun 2015
Scaphoid fracture nonunion treated with pronator quadratus pedicled vascularized bone graft and headless compression screw.
The purpose of our retrospective study was to evaluate the outcomes of scaphoid fracture nonunion treated with a pronator quadratus pedicled vascularized bone graft and a headless compression screw with regard to early wrist and thumb mobilization. From January 2008 to June 2011, 27 patients (20 men and 7 women; mean age, 24 years; age range, 15-32 years) with scaphoid fracture nonunion were treated with a pronator quadratus pedicled vascularized bone graft and a headless compression screw, and who met our inclusion criteria, including symptomatic scaphoid waist fracture nonunion with or without compromised vascularity and carpal instability. We evaluated radiologic assessment (correction of carpal instability and union rate). ⋯ The final average range of motion was as follows: wrist flexion, 73 degrees (range, 65-85 degrees); extension, 69 degrees (range, 60-80 degrees); ulnar deviation, 36 degrees (range, 15-50 degrees); and radial deviation, 22 degrees (range, 10-35 degrees). The average postoperative modified Mayo wrist score and disabilities of the arm, shoulder and hand score were 92 points (range, 78-100 points) and 11 points (range, 0-32 points), respectively. Our results suggest that a pronator quadratus pedicled vascularized bone graft and internal fixation with a headless compression screw can yield satisfactory functional and radiographic outcomes in the treatment of scaphoid fracture nonunion.