Division of Dermatology, University of California at Los Angeles, Los Angeles, California, USA.
Dermatol Surg. 2010 Feb;36(2):198-202. doi: 10.1111/j.1524-4725.2009.01425.x. Epub 2009 Dec 21.
With wrong-site surgery being one of the major causes of medical lawsuits in the United States, tools to confirm location are essential. A previous survey of 300 Mohs surgeons revealed that 14% of malpractice cases were due to wrong-site surgery. In dermatologic surgery, photography is helpful in precisely locating biopsy sites.
We present a case series of 34 biopsy-proven cutaneous head and neck malignancies performed in our university-based dermatology clinic, comparing the reliability of patient and blinded dermatologist identification with that of biopsy-site photography.
Of 34 biopsy sites, the patient and the blinded dermatologist incorrectly identified four (12%). The patient alone incorrectly identified an additional six biopsy sites, resulting in a total of 10 (29%) cases incorrectly identified by the patient. There were no instances in which the patient correctly identified the biopsy site and the blinded dermatologist incorrectly identified it.
In our current medical environment, in which more than 90% of health care is delivered in a clinic setting, wrong-site surgery is certainly underreported. In adopting a zero-tolerance policy for wrong-site surgeries, biopsy-site photography saves time, money, and potential frustration, hopefully eliminating the number of excisions performed on the wrong site.
在美国，错误部位手术是医疗诉讼的主要原因之一，因此确认手术部位的工具至关重要。此前对 300 名 Mohs 外科医生进行的调查显示，14%的医疗事故案件是由于错误部位手术导致的。在皮肤科手术中，拍照有助于准确定位活检部位。
我们报告了在我们的大学皮肤科诊所进行的 34 例经活检证实的头颈部皮肤恶性肿瘤病例系列，比较了患者和盲法皮肤科医生与活检部位摄影的识别可靠性。
在 34 个活检部位中，有 4 个（12%）被患者和盲法皮肤科医生错误识别。仅患者单独错误识别了另外 6 个活检部位，导致总共 10 个（29%）病例被患者错误识别。没有患者正确识别活检部位而盲法皮肤科医生错误识别的情况。
在我们当前的医疗环境中，超过 90%的医疗服务是在诊所环境中提供的，错误部位手术肯定是报告不足的。在对错误部位手术采取零容忍政策时，活检部位摄影可以节省时间、金钱和潜在的挫折感，希望能够减少在错误部位进行的切除数量。
