Abstract:
BACKGROUND:Most managed care plans use a physician "gatekeeper" to control referrals to hand surgeons. The appropriateness of this model for upper extremity complaints has never been challenged. The purpose of this study was to evaluate the prior management of patients with elective hand disorders who present to a hand surgery clinic. METHODS:All patients presenting to a tertiary, academic medical center for a new-patient hand surgery evaluation from February 3, 2011, to June 15, 2011, were prospectively enrolled. Patients were evaluated for prior provider, diagnosis, treatment, and complications. Actual diagnosis, recommended workup, and appropriate treatment were determined independently by two experienced hand examiners. Traumatic injuries and surgeon disagreements in diagnosis and treatment were excluded, leaving 125 patients. RESULTS:Ninety-eight percent of patients had been evaluated by a primary care provider. Overall, the correct diagnosis was established 34 percent of the time. Nerve compression syndromes were diagnosed with the greatest accuracy (64 percent), whereas stenosing tenosynovitis was diagnosed correctly only 15 percent of the time. Before presentation, 74 percent of patients had undergone a study or intervention. On review, 70 percent of studies/interventions were deemed unnecessary. Advanced imaging was unwarranted in 90 percent of patients who received it. Seventeen percent of patients experienced a complication. Most (67 percent) were caused by a delay in diagnosis, whereas 33 percent resulted from an intervention. CONCLUSIONS:Health care providers less familiar with an examination of the hand often misdiagnose and mistreat common problems. A referral system may not be the most efficient means of delivering care to patients with elective hand maladies.
journal_name
Plast Reconstr Surgjournal_title
Plastic and reconstructive surgeryauthors
Hartzell TL,Shahbazian JH,Pandey A,Girson LA,Rubinstein R,Bojovic B,Bernthal N,Azari KK,Benhaim Pdoi
10.1097/PRS.0b013e31829acc74subject
Has Abstractpub_date
2013-09-01 00:00:00pages
381e-386eissue
3eissn
0032-1052issn
1529-4242pii
00006534-201309000-00019journal_volume
132pub_type
临床试验,杂志文章abstract::When neurofibroma involves the face, it can lead to a most disfiguring, destructive, and debilitating condition. Because of the unique aesthetic and functional properties of the face, the surgeon might hesitate to remove all of the involved soft tissues and facial nerves in a radical procedure. Involvement of the cran...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200204010-00002
更新日期:2002-04-01 00:00:00
abstract::The regeneration of bone with a biodegradable, biocompatible carrier and osteo-regenerative proteins may be possible if the carrier has the appropriate architecture to support osteoconduction and prevent soft-tissue prolapse into ablated bone segments. Using radiomorphometry and histomorphometry, our group assessed in...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199304000-00002
更新日期:1993-04-01 00:00:00
abstract:BACKGROUND:The debate over the legitimacy of silicone as a safe tool for soft-tissue augmentation has spanned well over half a century. Proponents concede that injections of questionable purity and/or of massive quantities have produced unfavorable outcomes. They assert that in experienced hands with "injectable-grade"...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/01.prs.0000267580.92163.33
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:In academic institutions, residents make substantial contributions to clinical productivity. However, billing cannot be generated unless there is direct attending physician supervision of these services. The purpose of this study was to quantify clinical services provided by residents at a large academic med...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000002485
更新日期:2016-09-01 00:00:00
abstract::The definition, history, experimental background, surgical technique, and clinical applications of compound gracilis myocutaneous flaps are presented. This flap has been our method of choice for neo-vaginal reconstruction after radical pelvic surgery. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-197608000-00006
更新日期:1976-08-01 00:00:00
abstract::Extensive composite defects of the oromandibular area are usually created after the surgical treatment of T3 and T4 cancers, requiring complex reconstructive plastic surgical procedures. The preferred treatment method for this type of defect is reconstruction with two free flaps. The use of the vascularized fibula ost...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200201000-00008
更新日期:2002-01-01 00:00:00
abstract::The infracture technique for reduction malarplasty has been widely used as an aesthetic surgical procedure in northeast Asia. Since 1988, the authors' original method of infracture technique was performed through the combined approach of intraoral and temporopreauricular incision, which may leave a rather long scar on...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000110217.60491.56
更新日期:2004-04-01 00:00:00
abstract::The distally based radial artery forearm flap has become our workhorse flap for hand and finger coverage, relying on reversed or retrograde venous outflow through the venae comitantes. Free-flap transfer, however, has been used by us only with antegrade venous anastomoses. This study was intended to determine if a sin...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199202000-00006
更新日期:1992-02-01 00:00:00
abstract::Segmental Le Fort I osteotomy, a complex procedure with many mobile parts, has traditionally required presurgical orthodontics with conventional braces, composed of metal brackets, bands, and archwires. These appliances are not always accepted by patients, particularly older teenagers and professional adults who previ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000004491
更新日期:2018-07-01 00:00:00
abstract:BACKGROUND:There are few studies that compare the deep inferior epigastric artery perforator (DIEP) flap to the pedicled transverse rectus abdominis myocutaneous (pTRAM) flap for use in reconstructive breast surgery. The authors examined four factors that aid in decision-making: donor-site morbidity, need for surgery r...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0000000000001747
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:The thoracodorsal artery perforator flap was described mainly for partial breast reconstruction by Hamdi. The purpose of this article is to describe the use of the pedicled thoracodorsal artery perforator flap for total autologous breast reconstruction without using an implant. METHODS:Between January of 20...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000436843.15494.ad
更新日期:2014-02-01 00:00:00
abstract::Forty axial-pattern skin flaps in 10 pigs were studied, and 50 and 15 mu radioactively tagged microspheres were used to study blood flow at 2 days and 7 days after surgical delay. Blood flow increased during this period. No statistically significant change in the index of non-nutrient flow, an expression of arterioven...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198003000-00008
更新日期:1980-03-01 00:00:00
abstract::In a number of congenital, developmental, and postoperative conditions, many patients have a difference in the vertical and anteroposterior position of the ears. On correction of this deformity, the most difficult problem is the low and anterior location of the external auditory canal. To overcome this unyielding limi...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199912000-00006
更新日期:1999-12-01 00:00:00
abstract:BACKGROUND:Oncoplastic reduction mammaplasty offers patients breast conservation with the added benefit of functional improvement in symptoms related to macromastia. The reduction can be performed in the immediate setting with the lumpectomy, in a staged-immediate fashion after final pathology has been confirmed or in ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3182131c1c
更新日期:2011-06-01 00:00:00
abstract::Chlorpromazine administered to Sprague-Dawley rats 30 minutes prior to elevation of McFarlane back flaps and continued 14 days thereafter resulted in near complete flap survival, compared with 48 percent necrosis in control animals. Chlorpromazine demonstrates a wide variety of actions that appear to meet all presentl...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198606000-00014
更新日期:1986-06-01 00:00:00
abstract:BACKGROUND:Recent publications have implicated computed tomographic scans in the genesis of cancer and developmental delay. To determine whether the imaging protocols used in the authors' craniofacial practice could be harmful, they reviewed patient radiation exposure data for 77 patients. They then reviewed the litera...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3181b59d2d
更新日期:2009-10-01 00:00:00
abstract::Three instances of inappropriate ADH syndrome following craniofacial operations are reported. The cornerstone to diagnosis is careful fluid and electrolyte monitoring. Treatment consists of fluid restrictions in the acute phase and demeclocycline for refractory cases. Seizures should be symptomatically treated. Surgeo...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198301000-00001
更新日期:1983-01-01 00:00:00
abstract::A tape and applicator designed to give preoperative blepharoplasty patients an idea of the proposed result has been developed. The use of the tape as a cosmetic device to temporarily give the effect of a surgical blepharoplasty is presented. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198511000-00024
更新日期:1985-11-01 00:00:00
abstract::This retrospective chart review study examined the mental health histories and psychiatric medication usage of persons who sought cosmetic surgery. The medical records of 232 patients who had undergone a consultation for a cosmetic procedure were reviewed. The rates of self-reported psychiatric disorders and of psychi...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000142999.86432.1f
更新日期:2004-12-01 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:BACKGROUND:Complete corrugator supercilii muscle resection is important for the surgical treatment of migraine headaches and may help prevent postoperative abnormalities in surgical forehead rejuvenation. Specific topographic analysis of corrugator supercilii muscle dimensions and its detailed association with the supr...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000282725.61640.e1
更新日期:2007-11-01 00:00:00
abstract:LEARNING OBJECTIVES:After studying this article, the participant should be able to: 1. Describe the differential diagnosis of breast tumors in adolescent girls. 2. Compare and contrast surgical options for the management of adolescent breast tumors. 3. Recognize the utility of a reduction mammaplasty technique when res...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/01.prs.0000264396.03452.62
更新日期:2007-07-01 00:00:00
abstract::Complications after a median sternotomy incision, which is used currently in most cardiac and mediastinal surgical procedures, although infrequent, are serious. If sternal dehiscence follows median sternotomy, infection extends to vital underlying structures, exposing the anterior part of the heart and ascending aorta...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198511000-00008
更新日期:1985-11-01 00:00:00
abstract::In an attempt to obtain objective analysis of outcome in reduction mammaplasty patients, a retrospective study was done for women having elective bilateral reduction mammaplasty. Participants were chosen from a pool of over 200 consecutive reduction mammaplasty patients at the University of Missouri-Columbia. Of those...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199609000-00013
更新日期:1996-09-01 00:00:00
abstract::The aim of the present study was to evaluate the alterations of symptoms and tactile sensibility of the breast after reduction mammaplasty. In a prospective study, 10 women were operated on using the inferior pedicle technique. The patients were examined and interviewed preoperatively and at 2 weeks and 3 and 12 month...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.PRS.0000037749.88018.21
更新日期:2003-01-01 00:00:00
abstract::The role of the plastic surgeon in the diagnosis and management of congenital anomalies is often a complicated one that involves the integration of input from numerous specialists into the evaluation process. Diastematomyelia is a serious neurosurgical problem that often presents with cutaneous findings in a neurologi...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1995-07-01 00:00:00
abstract:BACKGROUND:Limitations in autogenous tissue have inspired the study of alternative materials for repair of complex peripheral nerve injuries. Cadaveric allografts are one potential reconstructive material, but their use requires systemic immunosuppression. Cold preservation (> or =7 weeks) renders allografts devoid of ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000245341.71666.97
更新日期:2007-01-01 00:00:00
abstract::Multicenter clinical trials are important research tools. Planning a multicenter clinical trial is a long and arduous task that requires substantial preparation time. In this guide, the authors discuss the steps used to plan a multicenter clinical trial. A preplanning phase, which involves formulating and refining a r...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/PRS.0b013e3181df64fa
更新日期:2010-08-01 00:00:00
abstract::The transverse rectus abdominis musculocutaneous flap is widely used for breast reconstruction, but it does not have a rich blood supply. A previous article described the inclusion of superficial epigastric vessels and superficial circumflex iliac vessels to "supercharge" the flap. Subsequent experience has shown that...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199309001-00033
更新日期:1993-09-01 00:00:00
abstract::A simple method of umbilical repositioning by incising the anterior rectus sheath and rectus abdominis muscle is reported for cases of unilateral abdominal wall plication during the TRAM flap operation. This method keeps the umbilicus stable and nonstenotic, and it avoids hypertrophic scars, which result from other te...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199912000-00029
更新日期:1999-12-01 00:00:00