Plastic Surgery SCGH Unit Audit 20 th of September – 5 th of December 2004 Marosh Vrtik Lip Teh David Oliver

Plastic Surgery SCGHPlastic Surgery SCGH

Unit AuditUnit Audit

2020thth of September – 5 of September – 5thth of of December 2004December 2004

Marosh VrtikMarosh VrtikLip TehLip Teh

David OliverDavid Oliver

OVERVIEWOVERVIEW

Outpatient ClinicsOutpatient Clinics Plastics Dressings ClinicPlastics Dressings Clinic Inpatient InformationInpatient Information Operative DataOperative Data ComplicationsComplications PresentationPresentation DiscussionDiscussion

Outpatient Clinic Case LoadOutpatient Clinic Case LoadFolloFollow upw up

NewNew TotalTotal Year To Year To DateDate

P. BriggsP. Briggs 166166 5151 217217 924924

C. AllenC. Allen 9494 3333 127127 516516

T. CooperT. Cooper 122122 4646 168168 682682

S. S. HamiltonHamilton

157157 4141 198198 775775

R. PageR. Page -- -- -- 145145

J. J. SavundraSavundra

1919 55 2020 4646

TOTALTOTAL 558558 176176 730730 30883088

Outpatient Clinic Case LoadOutpatient Clinic Case Load

2002: 31672002: 3167

2003: 31952003: 3195

2004: 32892004: 3289

0

500

1000

1500

2000

2500

3000

2002 2003 2004

New

Fup

Plastics Dressings ClinicPlastics Dressings Clinic

Audit PeriodAudit Period

New CasesNew Cases 303303

Follow upFollow up 16381638

Total:Total: 19411941

Plastics Dressings ClinicPlastics Dressings Clinic

20022002 20032003 20042004

New New CasesCases

10011001 10711071 13321332

Follow upFollow up 67326732 67296729 74787478

Total:Total: 77337733 78007800 88108810

AdmissionsAdmissionsAudit Audit PeriodPeriod

ALOSALOS

Allen C.Allen C. 7171 2.992.99

Briggs P.Briggs P. 118118 2.172.17

Hanikeri M.Hanikeri M. 22 3.53.5

Cooper T.Cooper T. 100100 1.991.99

Hamilton S.Hamilton S. 4343 3.883.88

Love R.Love R. 55 3.003.00

Savundra J.Savundra J. 7676 1.871.87

TOTALTOTAL 331331 2.022.02

AdmissionsAdmissions

20022002 20032003 20042004

incompletincompletee

Unit Total:Unit Total: 18511851 18411841 19121912

Unit Unit ALOS:ALOS:

3.323.32 2.632.63 2.792.79

Operations by Providers Audit Operations by Providers Audit PeriodPeriod

Allen C. 60Allen C. 60 Briggs P. 100Briggs P. 100 Cooper T. 91 Cooper T. 91 Hamilton S. 40Hamilton S. 40 Hanikeri M. 5Hanikeri M. 5 Love R. 6Love R. 6 Savundra J. 45Savundra J. 45 TOTAL:TOTAL: 347 347

OperationsOperations

20022002 20032003 20042004

IncompletIncompletee

TotalTotal 16931693 17221722 18291829

Operations by CategoriesOperations by Categories General Plastics 159General Plastics 159 Hand Surgery 152Hand Surgery 152 Breast Surgery 19 Breast Surgery 19 Craniofacial 16 Craniofacial 16 Microsurgery 7 Microsurgery 7 Head and Neck 7Head and Neck 7 Cosmetic Surgery 4Cosmetic Surgery 4 Burns 0Burns 0

TOTALTOTAL: 363: 363

FLAPSFLAPS

FREE FREE : TRAM 3: TRAM 3 Radial forearm 1Radial forearm 1

Rectus myocutaneous 2 Rectus myocutaneous 2 Thumb replantThumb replant 1 1

PedicledPedicled: Lat Dorsi 4: Lat Dorsi 4 Gastrocnemius 1Gastrocnemius 1 Reverse Radial Forearm 1Reverse Radial Forearm 1 TRAM 2TRAM 2

Operative ExperienceOperative ExperienceLip TEHLip TEH

AssistanceAssistance 11stst Operator OperatorMicrosurgeryMicrosurgery 00 44

Hand SurgeryHand Surgery 33 9292

General PlasticsGeneral Plastics 44 6262

Breast SurgeryBreast Surgery 33 1010

Head and NeckHead and Neck 11 11

CosmeticsCosmetics 22 00

CraniofacialCraniofacial 55 99

Total: Total: 187187

Operative ExperienceOperative ExperienceMarosh VrtikMarosh Vrtik AssistanceAssistance 11stst Operator Operator


General General plasticsplastics

77 4747

Breast Breast SurgerySurgery

44 00

Head and Head and neckneck

44 00


CosmeticCosmetic 22 00

MicroMicro 00 22

TotalTotal: 125: 125

Operative ExperienceOperative ExperienceDavid OliverDavid Oliver AssistanceAssistance 11stst Operator Operator


General General plasticsplastics

88 3535

Breast Breast SurgerySurgery

77 44

Head and Head and neckneck

11 00


CosmeticCosmetic 11 00

MicroMicro 00 33

TotalTotal: 128: 128

Use of Elective Lists for TraumaUse of Elective Lists for TraumaDuring Audit PeriodDuring Audit Period

41 registrar lists (11 weeks)41 registrar lists (11 weeks) 3 cases per list -> 123 slots 3 cases per list -> 123 slots

availableavailable 225 trauma cases225 trauma cases 60 trauma cases on elective lists i.e. 60 trauma cases on elective lists i.e.

“cancellations”“cancellations”

Time from Presentation to Time from Presentation to SURGERYSURGERY

18 Patients18 Patients Range: 1.75 – 48 hoursRange: 1.75 – 48 hours Average: 13.8 hoursAverage: 13.8 hours < 6 hours 7 patients < 6 hours 7 patients > 6 hours 2 patients> 6 hours 2 patients >12 hours 3 patients>12 hours 3 patients >18 hours 2 patient>18 hours 2 patient >24 hours 3 patients>24 hours 3 patients 48 hours 1 patient48 hours 1 patient

Complications: Incomplete Complications: Incomplete excisionsexcisions

110 Patients with cutaneous lesions110 Patients with cutaneous lesions

7 (6%) incomplete excisions for skin lesions7 (6%) incomplete excisions for skin lesions Clive Foley (SCC-insitu cheek) – HamiltonClive Foley (SCC-insitu cheek) – Hamilton Dawn Brennan (BCC nose) – AllenDawn Brennan (BCC nose) – Allen Marion Rawlings (BCC ear) – CooperMarion Rawlings (BCC ear) – Cooper Ronald Fernihough (SCC parotid) - AllenRonald Fernihough (SCC parotid) - Allen Richard Roberts (BCC scalp) – CooperRichard Roberts (BCC scalp) – Cooper Trevor Graham (melanoma chest) - HamiltonTrevor Graham (melanoma chest) - Hamilton Hector Mason (BCC ear) - CooperHector Mason (BCC ear) - Cooper

Complications: Level 3Complications: Level 3

Eric KayEric Kay Mr. Mr. AllenAllen 72 year old man72 year old man Adenoid cystic carcinoma Rt MaxillaAdenoid cystic carcinoma Rt Maxilla

Maxillectomy and reconstruction with free Maxillectomy and reconstruction with free rectus flap and rib grafts 5.11.04rectus flap and rib grafts 5.11.04

Reexplored 7.11.04 ?venous congestionReexplored 7.11.04 ?venous congestion Opthalmoplegia, pulmonary oedema, left Opthalmoplegia, pulmonary oedema, left

sided pneumonia, staph sepsissided pneumonia, staph sepsis


Rebecca FERNANDEZRebecca FERNANDEZ Mr. Mr. AllenAllen 20 year old female20 year old female T4 N1 M0 SCC tongueT4 N1 M0 SCC tongue

Glossectomy, bilateral neck dissection and Glossectomy, bilateral neck dissection and reconstruction with free rectus flap 22.10.04reconstruction with free rectus flap 22.10.04

Reexplored 23.10.04 ?arterial occlussionReexplored 23.10.04 ?arterial occlussion Tongue flap debulked 3 weeks laterTongue flap debulked 3 weeks later


Earl BOXALLEarl BOXALL Mr. Mr. CooperCooper 54 year old male54 year old male T3 N1 SCC floor of mouthT3 N1 SCC floor of mouth

WLE, marginal mandibulectomy, bilateral WLE, marginal mandibulectomy, bilateral neck dissection and reconstruction with free neck dissection and reconstruction with free radal forearm flap 22.11.04radal forearm flap 22.11.04

Reexplored 23.11.04 venous occlussionReexplored 23.11.04 venous occlussion 1 vein thrombosed, 1 vein kinked1 vein thrombosed, 1 vein kinked

Incomplete excision – reexcision planned Incomplete excision – reexcision planned 20.12.0420.12.04


Diane KIRBYDiane KIRBY Mr. AllenMr. Allen 55 year old woman55 year old woman LT Lar Dorsi and Expander Breast Recon LT Lar Dorsi and Expander Breast Recon

24.9.0424.9.04 Cellulitis and ?Ruptured expander 11.12.04Cellulitis and ?Ruptured expander 11.12.04 Removal of expander 15.12.04Removal of expander 15.12.04

Micro coag neg staphMicro coag neg staph

Complications Level 3Complications Level 3

Laura GRIMESLaura GRIMES Mr. AllenMr. Allen 50 yr old female 50 yr old female

Lt Lat dorsi and expander reconstruction Jan Lt Lat dorsi and expander reconstruction Jan 0404

Admitted for cellulitis 5.11.04Admitted for cellulitis 5.11.04 Unresponsive to IV antibioticsUnresponsive to IV antibiotics Washout and implant removal 10.11.04Washout and implant removal 10.11.04

Micro no growthMicro no growth


Olive CARBONIOlive CARBONI Mr. AllenMr. Allen 69 year old female69 year old female Lt calf degloving lacerationLt calf degloving laceration

Suture repair 2.10.04Suture repair 2.10.04 Flap necrosis and cellulitisFlap necrosis and cellulitis Debridement and SSG 11.10.04Debridement and SSG 11.10.04


Craig DIXONCraig DIXON Mr. Mr. CooperCooper 28 year old man28 year old man Post traumatic scar contracture left third Post traumatic scar contracture left third

rayray Scar release, Z plasties 12.10.04Scar release, Z plasties 12.10.04 Skin necrosis, exposed flexor tendonsSkin necrosis, exposed flexor tendons Cross finger flap 21.10.04Cross finger flap 21.10.04


Timothy GROUNDSTimothy GROUNDS Mr. Mr. Savundra/LoveSavundra/Love

- 40 yr old man- 40 yr old man

- Bilateral buttock pressure ulcers- Bilateral buttock pressure ulcers

- Debrided 29.10.04- Debrided 29.10.04

- Direct closure Lt side 2.12.04- Direct closure Lt side 2.12.04

dehisced following seizuredehisced following seizure

- SSG 13.12.04- SSG 13.12.04


Cheryl BUCHANENCheryl BUCHANEN Mr. BriggsMr. Briggs 50yr old female 50yr old female

Bilateral wrist lacerationsBilateral wrist lacerations Repaired 10.11.04Repaired 10.11.04 Infected with enterobacter cloacaeInfected with enterobacter cloacae Washout 15.11.04 – ruptured FCRWashout 15.11.04 – ruptured FCR


Anne HULLAnne HULL Mr. SavundraMr. Savundra 52yr old female 52yr old female

Rt leg laceration from lawn moverRt leg laceration from lawn mover Repaired 19.11.04Repaired 19.11.04 Skin necrosis/cellulitisSkin necrosis/cellulitis Debrided 26.11.04Debrided 26.11.04 SSG 31.11.04SSG 31.11.04


Richard ROBERTSRichard ROBERTS Mr. CooperMr. Cooper 70 yr old male 70 yr old male

BCC scalp 26.11.04BCC scalp 26.11.04 Excision and SSG Excision and SSG Hematoma, loss of SSG, incomplete excision Hematoma, loss of SSG, incomplete excision Reexcision and SSG 3.12.04Reexcision and SSG 3.12.04


Andrea SKAHILLAndrea SKAHILL Mr. HamiltonMr. Hamilton 41yr old female 41yr old female

MunchausensMunchausens Chronic Left thigh ulcerChronic Left thigh ulcer Debridement and SSG harvest 21.10.04Debridement and SSG harvest 21.10.04 Complete SSG lossComplete SSG loss Debrided, SSG harvest and tension banding Debrided, SSG harvest and tension banding

2.12.042.12.04


Kevin THOMPSONKevin THOMPSON Mr. CooperMr. Cooper 43 yr old male 43 yr old male

Bilateral trigger finger releases Bilateral trigger finger releases (RIF,RMF,RRF,LMF,LRF) 5.10.04(RIF,RMF,RRF,LMF,LRF) 5.10.04

RIF still triggeringRIF still triggering Explored LAOP 18.11.04Explored LAOP 18.11.04

Synovectomy, partial A2 pulley releaseSynovectomy, partial A2 pulley release

Documents

Plastic Surgery SCGH Unit Audit 20 th of September – 5 th of December 2004 Marosh Vrtik Lip Teh David Oliver