Tebbetts John B, Adams William P
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Plast Reconstr Surg. 2006 Dec;118(7 Suppl):35S-45S. doi: 10.1097/01.prs.0000191163.19379.63.
Surgeons' decisions impact patient outcomes and implant effects on tissues over time. Tissue assessment systems that provide quantitative, objective data enable objective rather than subjective decisions. First-generation dimensional systems for breast augmentation defined a desired result dimensionally and recommended an implant to force tissues to the desired result. A second-generation system, the TEPID system, defines measurements to match the implant to the patient's tissue characteristics, instead of forcing tissues to a desired result. This study defines a third-generation decision support process that prioritizes five critical decisions, identifies five key measurements, and completes all preoperative assessment and operative planning decisions in breast augmentation in 5 minutes or less.
Key decision parameters and data from more than 2300 primary augmentations planned using the TEPID system were analyzed to define the five most critical decisions that affect reoperation rates and risks of uncorrectable deformities and to define a decision support process using five critical measurements.
In 1664 cases with up to 7 years of follow-up, the overall reoperation rate was 3 percent, and the reoperation rate for implant size exchange was 0.2 percent. The junior author's (Adams) clinical experience includes more than 300 augmentations with up to 6 years of follow-up using this system, with an overall reoperation rate of 2.8 percent.
The High Five decision support process prioritizes five critical decisions in breast augmentation and enables surgeons to address all preoperative assessment and operative planning decisions in breast augmentation in 5 minutes or less.
外科医生的决策会影响患者的治疗结果以及植入物对组织的长期影响。能够提供定量、客观数据的组织评估系统有助于做出客观而非主观的决策。第一代隆胸尺寸系统从尺寸上定义了理想的结果，并推荐使用植入物来迫使组织达到理想结果。第二代系统，即TEPID系统，定义了一些测量方法，以便根据患者的组织特征来匹配植入物，而不是迫使组织达到理想结果。本研究定义了一种第三代决策支持流程，该流程优先考虑五个关键决策，确定五个关键测量指标，并能在5分钟或更短时间内完成隆胸手术的所有术前评估和手术规划决策。
分析了使用TEPID系统规划的2300多例初次隆胸手术的关键决策参数和数据，以确定影响再次手术率和不可纠正畸形风险的五个最关键决策，并使用五个关键测量指标定义一个决策支持流程。
在1664例随访时间长达7年的病例中，总体再次手术率为3%，植入物尺寸更换的再次手术率为0.2%。第一作者（亚当斯）的临床经验包括使用该系统进行的300多例隆胸手术，随访时间长达6年，总体再次手术率为2.8%。
“五要素”决策支持流程在隆胸手术中优先考虑五个关键决策，并使外科医生能够在5分钟或更短时间内完成隆胸手术的所有术前评估和手术规划决策。
