Abstract:
BACKGROUND:Most lesions of the upper extremity are common and benign, and many have questioned the need for routine pathologic evaluation of these specimens. The authors aim to examine the national use of routine pathologic examination of nonmalignant hand lesions to help guide health care policy and practice patterns. METHODS:The authors used a national level MarketScan database to form a cohort of adult patients who underwent excision of nonmalignant upper extremity lesions. The authors calculated the rate of submission for each surgical procedure and separately for each diagnosis. The authors also investigated demographic and clinical characteristics associated with the submission of surgical specimens using a multivariable logistic regression model. The authors calculated the total cost of routine pathologic evaluation. RESULTS:The final study cohort included 222,947 patients and 182,962 specimens from 153,518 cases. The mean rate of submission was 69 percent. Older age, Northeast region, and high comorbidity scores showed significant correlation with the odds of having a specimen submitted for pathologic evaluation. Excision of primary wrist ganglion was the most performed procedure, and benign lesions larger than 4.0 cm were most frequently submitted for pathologic evaluation. The mean cost of routine pathologic examination was $133 per specimen, and the annual expenditure was $5 million. CONCLUSIONS:The routine pathologic examination of benign hand lesions is used frequently but provides limited clinical benefit at a cost. To increase efficiency and improve quality of care, surgeons should be aware of the low value of routine pathologic evaluation and be more selective for cases for which diagnostic testing will change management.
journal_name
Plast Reconstr Surgjournal_title
Plastic and reconstructive surgeryauthors
Cho HE,Kelley B,Zhong L,Chung KCdoi
10.1097/PRS.0000000000004592subject
Has Abstractpub_date
2018-08-01 00:00:00pages
160e-168eissue
2eissn
0032-1052issn
1529-4242pii
00006534-201808000-00024journal_volume
142pub_type
杂志文章abstract::The titanium hollow screw reconstruction plate (THORP) system for reconstruction of lower jaw defects provides a functional stable fixation and is used as a long-term or permanent implant in tumor surgery and in traumatology. The rigid fixation of the head of the screw to the plate, avoiding unphysiologic loads to the...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198811000-00013
更新日期:1988-11-01 00:00:00
abstract:BACKGROUND:Skeletal muscle trauma can produce grave functional deficits, but therapeutic options remain limited. The authors studied whether a decellularized skeletal muscle scaffold would provide benefits in inducing skeletal muscle regeneration over acellular dermal matrices. METHODS:Eighty-two rat muscle defects we...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000006922
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:The deep inferior epigastric perforator (DIEP) flap, which is a modification of the muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flap, is being more frequently used in an effort to reduce postoperative abdominal morbidity. However, there is no consensus as to which of these flaps i...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000003843
更新日期:2017-12-01 00:00:00
abstract::A primary gastrocnemius transposition flap is a useful technique for prosthetic coverage following extensive soft-tissue and bone resection for sarcomas of the knee joint. The gastrocnemius transposition flap is also a useful secondary procedure to treat local complications following attempted limb-sparing surgery. Th...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198405000-00004
更新日期:1984-05-01 00:00:00
abstract::The effect of total maxillary advancement on the growing skull was examined in 25 pigs, subjected to facial operations of varied severity at the age of 5 weeks (elevation of periosteum, simple osteotomy, and osteotomy immobilized by wire fixation, with or without bone grafts) and in controls. When the animals were kil...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-197811000-00015
更新日期:1978-11-01 00:00:00
abstract:BACKGROUND:Cranial vault remodeling procedures are carried out for both syndromic and nonsyndromic craniosynostosis as well as to correct some acquired deformities of the cranial vault. These procedures improve not only cosmesis but also neurological symptoms. The purpose of this study was to determine the incidence of...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000277997.56941.e5
更新日期:2007-09-15 00:00:00
abstract:BACKGROUND:Nonsteroidal antiinflammatory drugs are useful alternatives to narcotics for analgesia. However, concerns remain regarding their safety. The authors evaluated ketorolac use and complications. We hypothesized that no association between ketorolac and morbidity exists in patients undergoing body contouring. M...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000004806
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND:The combination of endoscope-assisted suturectomy and postoperative helmet therapy has been advocated to treat unilateral coronal synostosis. However, surgical outcomes can vary. One possible explanation for this inconsistency is early closure of the craniectomy gap. The authors examined short-term postopera...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000000285
更新日期:2014-07-01 00:00:00
abstract::The rat model of the transverse rectus abdominis musculocutaneous (TRAM) flap was used in the present study to determine the effects of external beam radiation on myocutaneous flap histology and pathophysiology. A total of 57 adult Sprague-Dawley rats underwent a TRAM procedure. A pilot study with 17 animals was first...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200104150-00014
更新日期:2001-04-15 00:00:00
abstract::Rehydrated freeze-dried microarterial allografts were implanted to bridge arterial defects using New Zealand White rabbits as the experimental model. Segments of artery from the rabbit ear and thigh were harvested and preserved for a minimum of 2 weeks after freeze-drying. These allografts, approximately 1 mm in diame...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199002000-00014
更新日期:1990-02-01 00:00:00
abstract::Although externally exposed ventricular assist devices are associated with extremely high mortality rates, salvage may be accomplished by early aggressive wound debridement, transposition of a well-perfused autologous tissue (such as omentum), dead space obliteration, and adequate external coverage using vascularized ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199812000-00025
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:This study was conducted to compare the gastrostomy rates in infants with Pierre Robin sequence treated with tongue-lip adhesion or mandibular distraction osteogenesis. METHODS:This was a retrospective study of symptomatic plastic and reconstructive surgery patients treated over an 8-year period. The primar...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/PRS.0000000000002865
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:The authors assessed the safety and efficacy of a novel cleft rhinoplasty procedure that combines an open rhinoplasty with the Dibbell and Tajima techniques. METHODS:A single-surgeon, 10-year, retrospective review was conducted of all unilateral cleft lip rhinoplasties (n = 157). Nonsyndromic patients under...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3181bcf100
更新日期:2009-12-01 00:00:00
abstract::Constriction rings are associated with amniotic band syndrome and most often present in the extremities. Constriction bands of the trunk are rare, and a standard of surgical care remains elusive. Traditional methods of constriction ring excision rely on soft-tissue rearrangement with multiple Z-plasties, but renewed i...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000000903
更新日期:2015-02-01 00:00:00
abstract::Surgery is accepted as one of the most demanding professions that create both physical and mental strain on the performers. Therefore, the authors aimed to elucidate the mental burden of surgeons, which is dedicated to operative stress. They also tested the hypotheses that participating in surgery creates mental stres...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000133166.50279.7c
更新日期:2004-09-15 00:00:00
abstract::A thick nostril is a disturbing deformity and one for which surgeons and patients may be reluctant to employ the traditional "piece of pie" skin excisions commonly described. As an alternative in selected circumstances, a method of internally thinning the nostril rim using an alar base groove incision known as alar ri...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199604000-00023
更新日期:1996-04-01 00:00:00
abstract:BACKGROUND:Despite a 12 to 82 percent pressure ulcer recurrence rate, no standard protocol exists for postoperative management. The authors reviewed a single surgeon's experience using a standard protocol: surgery and immediate reconstruction regardless of nutrition, intraoperative bone culture guiding postoperative an...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3182442197
更新日期:2012-04-01 00:00:00
abstract::The case is presented of a primary toe-to-thumb transfer by microvascular anastomosis for reconstruction of an acute degloving amputation of the thumb. This approach is not recommended as the standard practice for this type injury, however, there were certain advantages in this patient: (1) one stage procedure, (2) re...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1981-02-01 00:00:00
abstract::Vasospasm in revascularized tissue can compromise tissue perfusion even though the microsurgical anastomoses remain patent. Circulating catecholamine stimulates peripheral vasoconstriction. Chemical vasospasm was induced by the intraarterial administration of norepinephrine to denervated rat hind limbs. Heel pad blood...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198502000-00016
更新日期:1985-02-01 00:00:00
abstract:BACKGROUND:The major drawback of adipose grafting is its clinical unpredictability, which leads to surgeon and patient dissatisfaction. The mechanisms underlying angiogenesis and regeneration of the graft tissue are still unclear. METHODS:Mouse adipose tissue was processed using two different methods (fragmental and i...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000000965
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Cesarean delivery is one of the most commonly performed surgeries in the United States. Compared with other surgical procedures, surgical site infection tends to be a relatively uncommon outcome after cesarean delivery in the general population with an incidence rate between 1.46 and 3.82% in the United Stat...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0000000000005309
更新日期:2019-01-01 00:00:00
abstract::Several factors may increase a patient's risk for perioperative pulmonary complications. This practice advisory provides an overview of the preoperative steps that should be performed to ensure appropriate patient selection and patient safety with regard to pulmonary complications. Procedural and patient-related risk ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0b013e3181b53fb0
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:Insufficient soft-tissue coverage following total knee arthroplasty jeopardizes prosthesis retention and may lead to significant complications. The aim of this study was to evaluate the natural history of total knee arthroplasty following flap reconstruction of soft-tissue defects. METHODS:A retrospective r...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000001929
更新日期:2016-01-01 00:00:00
abstract:BACKGROUND:De novo or rare transmitted mutations in the SMAD6 gene affect 7 percent of midline nonsyndromic synostosis patients. This study aimed to determine the neurocognitive sequelae of SMAD6 synostosis. METHODS:Nonsyndromic synostosis patients 6 years or older with SMAD6 mutations and non-SMAD6 nonsyndromic synos...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000006319
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:The α-gal epitope is a carbohydrate antigen that interacts specifically with the natural anti-Gal antibody--the most abundant antibody in humans. Anti-Gal/α-gal epitope interaction activates complement to generate chemotactic factors that induce rapid recruitment of macrophages. The authors hypothesized that...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e31823aebb1
更新日期:2012-02-01 00:00:00
abstract::A model simulating intraosseous wire fixation was used to assess different methods of securing wire loops. Square knotting, twisting, and a new method, the "knot twist," were assessed. The importance of anchoring the butt ends of twisted wire is emphasized. A new, convenient technique of wire fixation is described. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1988-06-01 00:00:00
abstract::Not only is the long temporal vertical flap not centered on the temporosuperficial artery, but it is also countercurrent to this artery. The difficulties of its design are largely compensated for by the natural aspect of the anterior area once achieved. It must be emphasized that all techniques of transplantation can ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198411000-00007
更新日期:1984-11-01 00:00:00
abstract:BACKGROUND:Since the inception of microvascular free tissue transfer, flap monitoring has been based on clinical signs. Color, capillary refill, and handheld Doppler have been used for monitoring in the postoperative period; however, subjective clinical examination may delay recognition of flap compromise. Tissue oxime...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e31820436cb
更新日期:2011-03-01 00:00:00
abstract::The pathologic cause of both rare craniofacial clefts and congenital limb ring constrictions is the subject of some debate. Uncommon though these two conditions are, they have often been anecdotally reported in association. This study sought to determine the frequency of congenital limb anomalies in general and limb r...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199803000-00010
更新日期:1998-03-01 00:00:00
abstract:BACKGROUND:Since 2005, seven facial composite tissue allotransplantations have been performed in five different centers in three countries. Four teams have reported their outcomes in separate publications. The authors sought to review the first four global experiences and compare several factors. This review facilitate...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0b013e3181c722a8
更新日期:2010-02-01 00:00:00