PLASTIC SURGERY
References and Abstracts

1. Unique Identifier 99162934
Author Gorney M and Martello J
Title Patient selection criteria
Source Clinics in Plastic Surgery 26(1) p37-40
Abstract

Most malpractice claims are based on failures of communication and patient selection criteria, not on technical faults. This article examines the psychological aspects of plastic surgery and then discusses the role of effective communication as a claims prevention technique. The author delineate general characteristics of trouble-prone patient groups so that the surgeon may distinguish those patients whose body image and personality characteristics make them simply unsuitable for the elective aesthetic surgery that they seek

2. Unique Identifier 99162931
Author Gorney M
Title The wheel of misfortune. Genesis of malpractice claims
Source Clinics in Plastic Surgery 26(1) p15-19
Abstract

Unlike other surgical specialists, plastic surgeons attending patients who seek aesthetic improvement are not trying to make sick patients well, but rather well patients better. This not only places a much heavier burden of responsibility on the operating surgeons, but also subjects them to a much broader range of a patient's reasons for unhappiness. This article examines various fields of plastic surgery in terms of liability and offers advice on how best to reduce the frequency of such medical liability claims

3. Unique Identifier 99162948
Author Gorney M and Martello J
Title The genesis of plastic surgeon claims. A review of recurring problems
Source Clinics in Plastic Surgery 26(1) p123-131
Abstract

The authors examine several cases in which malpractice claims are the result of either poor documentation, lack of preoperative photographs, inadequate informed consent, or poor patient-selection criteria. In each case, they discuss what errors took place and the end result of the claim. The cases presented in the article are intended to help readers avoid potential medical malpractice traps in the future and be diligent with office documentation

4. Unique Identifier 20301899
Author Chang DW, Reece GP, Wang B, Robb GL, Miller MJ, Evans GR, Langstein HN, Kroll SS
Institution Department of Plastic and Reconstructive Surgery, University of Texas M. D. Anderson Cancer enter, Houston 77030, USA. dchang@mdanderson.org
Title Effect of smoking on complications in patients undergoing free TRAM flap breast reconstruction
Source Plast Reconstr Surg June 2000 105(7) p2374-2380
Abstract

Free pedicled transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction is often advocated as the procedure of choice for autogenous tissue breast reconstruction in high-risk patients, such as smokers. However, whether use of the free TRAM flap is a desirable option for breast reconstruction in smokers is still unclear. All patients undergoing breast reconstruction with free TRAM flaps at our institution between February of 1989 and May of 1998 were reviewed. Patients were classified as smokers, former smokers (patients who had stopped smoking at least 4 weeks before surgery), and nonsmokers. Flap and donor-site complications in the three groups were compared. Information on demographic characteristics, body mass index, and comorbid medical conditions was used to perform multivariate statistical analysis. A total of 936 breast reconstructions with free TRAM flaps were performed in 718 patients (80.9 percent immediate; 23.3 percent bilateral). There were 478 nonsmokers, 150 former smokers, and 90 smokers. Flap complications occurred in 222 (23.7 percent) of 936 flaps. Smokers had a higher incidence of mastectomy flap necrosis than nonsmokers (18.9 percent versus 9.0 percent; p = 0.005). Smokers who underwent immediate reconstruction had a significantly higher incidence of mastectomy skin flap necrosis than did smokers who underwent delayed reconstruction (21.7 percent versus 0 percent; p = 0.039). Donor-site complications occurred in 106 (14.8 percent) of 718 patients. Donor- site complications were more common in smokers than in former smokers (25.6 percent versus 10.0 percent; p = 0.001) or nonsmokers (25.6 percent versus 14.2 percent; p = 0.007). Compared with nonsmokers, smokers had significantly higher rates of abdominal flap necrosis (4.4 percent versus 0.8 percent; p = 0.025) and hernia (6.7 percent versus 2.1 percent; p = 0.016). No significant difference in complication rates was noted between former smokers and nonsmokers. Among smokers, patients with a smoking history of greater than 10 pack-years had a significantly higher overall complication rate compared with patients with a smoking history of 10 or fewer pack-years (55.8 percent versus 23.8 percent; p = 0.049). In summary, free TRAM flap breast reconstruction in smokers was not associated with a significant increase in the rates of vessel thrombosis, flap loss, or fat necrosis compared with rates in nonsmokers. However, smokers were at significantly higher risk for mastectomy skin flap necrosis, abdominal flap necrosis, and hernia compared with nonsmokers. Patients with a smoking history of greater than 10 pack-years were at especially high risk for perioperative complications, suggesting that this should be considered a relative contraindication for free TRAM flap breast reconstruction. Smoking-related complications were significantly reduced when the reconstruction was delayed or when the patient stopped smoking at least 4 weeks before surgery

5. Unique Identifier 99162951
Author Gorney M
Title Plastic surgery pitfalls
Source Clinics in Plastic Surgery 26(1) p149-159
Abstract

As a founding member of the physician-owned insurance carrier The Doctors' Company, the author has reviewed many plastic surgery policy claims. In this article, he presents an overview of the plastic surgery procedures that produce the most severe losses. He then offers suggestions on how to proceed with these "medical malpractice favorites." The author discusses potential antitrust traps and legal recourse for plastic surgeons

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