Vyas Krishna S, Hambrick H Rhodes, Shakir Afaaf, Morrison Shane D, Tran Duy C, Pearson Keon, Vasconez Henry C, Mardini Samir, Gosman Amanda A, Dobke Marek, Granick Mark S
From the *Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN; †New York University School of Medicine, New York City, NY; ‡Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, CA; §Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA; ∥Stanford University School of Medicine, Stanford, CA; ¶Division of Plastic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY; #Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, CA; and **Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Ann Plast Surg. 2017 Jun;78(6):736-768. doi: 10.1097/SAP.0000000000001044.
Telemedicine, the use of information technology and telecommunication to provide healthcare at a distance, is a burgeoning field with applications throughout medicine. Given the visual nature of plastic surgery and dermatology, telemedicine has a myriad of potential applications within the field.
A comprehensive literature review of articles published on telemedicine since January 2010 was performed. Articles were selected for their relevance to plastic and reconstructive surgery and dermatology, and then reviewed for their discussion of the applications, benefits, and limitations of telemedicine in practice.
A total of 3119 articles were identified in the initial query. Twenty-three articles met the inclusion criteria in plastic surgery (7 wound management, 5 burn management, 5 trauma, 4 free flap care, 2 in cleft lip/palate repair). Twenty-three (100%) reported a benefit of telemedicine often related to improved postoperative monitoring, increased access to expertise in rural settings, and cost savings, either predicted or actualized. Eight (35%) reported limitations and barriers to the application of telemedicine, including overdiagnosis and dependence on functional telecommunication systems. Sixty-six articles focused on telemedicine in dermatology and also demonstrated significant promise.
Telemedicine holds special promise in increasing the efficiency of postoperative care for microsurgical procedures, improving care coordination and management of burn wounds, facilitating interprofessional collaboration across time and space, eliminating a significant number of unnecessary referrals, and connecting patients located far from major medical centers with professional expertise without impinging on-and in some cases improving-the quality or accuracy of care provided. Teledermatology consultation was found to be safe and has a comparable or superior efficacy to the traditional in-patient consultation. The system was consistently rated as convenient and easy to use by patients, referring physicians, and consulting dermatologists. Teledermatology has also been used as an educational tool for patients. A significant number of studies detailed strategies to improve the current state of teledermatology, either by implementing new programs or improving technologies. Telemedicine use is widespread among plastic surgeons and is enabling the spread of expertise beyond major medical centers. Further research is needed to conclusively demonstrate benefit in routine clinical care.
远程医疗是利用信息技术和电信技术在远距离提供医疗保健服务，这是一个新兴领域，在医学各领域均有应用。鉴于整形手术和皮肤科的视觉特性，远程医疗在该领域有无数潜在应用。
对2010年1月以来发表的关于远程医疗的文章进行全面文献综述。选择与整形和重建手术以及皮肤科相关的文章，然后审查其对远程医疗在实践中的应用、益处和局限性的讨论。
在初始查询中总共识别出3119篇文章。23篇文章符合整形手术的纳入标准（7篇伤口管理、5篇烧伤管理、5篇创伤、4篇游离皮瓣护理、2篇唇腭裂修复）。23篇（100%）报告了远程医疗的益处，通常与改善术后监测、增加农村地区获得专业知识的机会以及节省成本（预测或实际实现）有关。8篇（35%）报告了远程医疗应用的局限性和障碍，包括过度诊断和对功能正常的电信系统的依赖。66篇文章聚焦于皮肤科的远程医疗，也显示出巨大潜力。
远程医疗在提高显微外科手术后护理效率、改善烧伤伤口护理协调和管理、促进跨时间和空间的跨专业协作、消除大量不必要的转诊以及将远离主要医疗中心的患者与专业知识联系起来而不影响（在某些情况下还改善）所提供护理的质量或准确性方面具有特殊前景。远程皮肤科会诊被发现是安全的，并且与传统的住院会诊具有相当或更高的疗效。该系统一直被患者、转诊医生和会诊皮肤科医生评为方便且易于使用。远程皮肤科还被用作患者的教育工具。大量研究详细阐述了改善当前远程皮肤科状况的策略，要么通过实施新计划，要么通过改进技术。远程医疗在整形外科医生中使用广泛，并且正在使专业知识超越主要医疗中心得以传播。需要进一步研究以确凿证明其在常规临床护理中的益处。
