Brandel Michael G, DʼSouza Gehaan F, Reid Christopher M, Dobke Marek K, Gosman Amanda A
From the Division of Plastic Surgery, Department of Surgery, UC San Diego Medical Center, San Diego, CA.
Ann Plast Surg. 2017 May;78(5 Suppl 4):S175-S179. doi: 10.1097/SAP.0000000000001048.
GOALS/PURPOSE: Plastic surgery residents often desire additional training in rhinoplasty than what is provided by their residency program. The goal of this study was to define and evaluate a specific process used to structure preoperative, intraoperative, and postoperative protocols for rhinoplasty patients in the resident aesthetic clinic (RAC) to enhance qualitative and quantitative experience. Complication rates and patient/resident satisfaction scores were also examined.
Resident clinic rhinoplasty patients underwent a well-defined and established process that included patient education and informed consent, preoperative planning in a conference-based session, specific adherence to established surgical techniques, and structured postoperative management and follow-up. This process also included supervision criteria for residents in the operating room and clinical setting. Patient and resident satisfaction at the RAC was evaluated by a Web-based survey. A database of procedural complications and methods was compiled and evaluated.
Between June 2012 and June 2015, 146 aesthetic resident cases were completed through the University of California, San Diego Residency Aesthetic Surgery Program. Of these cases, 34 (17%) were rhinoplasty procedures. Residents at our institution assisted on an average of 55 rhinoplasty procedures with the faculty and performed an average of 12 rhinoplasty procedures as primary surgeons. The residents surveyed felt that they had a good autonomous experience (P < 0.001), and 90% reported confidence with rhinoplasty. Postoperative complications were recorded and included asymmetry (n = 4, 10.5%), septal perforation (n = 1, 2.6%), and difficulty in breathing (n = 6, 15.8%). There were no patients who experienced infections, and the complication rate requiring revision in the operating room was 0%.
Optimizing protocols in rhinoplasty in an RAC has allowed for the RAC to flourish in the breadth and complexity of rhinoplasty operations. This has enabled residents to gain a structured and autonomous exposure to rhinoplasty cases. Cases were done with an acceptable complication rate and with good patient and resident satisfaction. This is a unique report in that it provides a structured process for preoperative, intraoperative, and postoperative care in rhinoplasty operations.
目标/目的：整形外科住院医师常常希望获得比其住院医师培训项目所提供的更多的鼻整形术培训。本研究的目的是定义和评估一种特定流程，该流程用于构建住院医师美容诊所（RAC）中鼻整形术患者的术前、术中和术后方案，以增强定性和定量的经验。还对并发症发生率以及患者/住院医师满意度评分进行了检查。
住院医师诊所的鼻整形术患者接受了一个明确且既定的流程，该流程包括患者教育和知情同意、基于会议的术前规划、对既定手术技术的特定遵循以及结构化的术后管理和随访。此流程还包括手术室和临床环境中对住院医师的监督标准。通过基于网络的调查评估了RAC中患者和住院医师的满意度。编制并评估了一份手术并发症及方法的数据库。
在2012年6月至2015年6月期间，通过加利福尼亚大学圣地亚哥分校住院医师美容外科项目完成了146例美容住院医师手术病例。在这些病例中，34例（17%）为鼻整形术。我们机构的住院医师平均与教员一起协助进行55例鼻整形术，作为主刀医师平均进行12例鼻整形术。接受调查的住院医师认为他们有良好的自主经验（P < 0.001），并且90%的人表示对鼻整形术有信心。记录了术后并发症，包括不对称（n = 4，10.5%）、鼻中隔穿孔（n = 1，2.6%）和呼吸困难（n = 6，15.8%）。没有患者发生感染，需要在手术室进行翻修的并发症发生率为0%。
在RAC中优化鼻整形术方案使得RAC在鼻整形手术的广度和复杂性方面得以蓬勃发展。这使住院医师能够有结构化且自主地接触鼻整形术病例。手术并发症发生率可接受，患者和住院医师满意度良好。这是一份独特的报告，因为它提供了鼻整形手术术前、术中和术后护理的结构化流程。
