Plastic and Reconstructive Surgery Guest Editor DEBORAH S. HICKMAN MATHIS, RN, MS, CNOR, RNFA PERIOPERATIVE NURSING CLINICS www.periopnursing.theclinics.com Consulting Editor NANCY GIRARD, PhD, RN, FAAN June 2011 • Volume 6 • Number 2 SAUNDERS an imprint of ELSEVIER, Inc. W.B.SAUNDERSCOMPANY ADivisionofElsevierInc. 1600JohnF.KennedyBoulevard(cid:2)Suite1800(cid:2)Philadelphia,Pennsylvania19103-2899 http://www.periopnursing.theclinics.com PERIOPERATIVENURSINGCLINICSVolume6,Number2 June2011ISSN1556-7931,ISBN-13:978-1-4557-7988-8 Editor:KatieHartner DevelopmentalEditor:DonaldMumford (cid:2)2011ElsevierInc.Allrightsreserved. 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PlasticandReconstructiveSurgery Contributors CONSULTING EDITOR NANCYGIRARD,PhD,RN,FAAN NurseCollaborations,Boerne,Texas;ClinicalAssociateProfessor,AcuteNursingCare Department,UniversityofTexasHealthScienceCenter,SanAntonio,Texas GUEST EDITOR DEBORAHS.HICKMANMATHIS,RN,MS,CNOR,RNFA RenuePlasticSurgery,RenueSurgeryCenter,Brunswick,Georgia AUTHORS ANDREAFASSIOTTO,RN OutpatientSurgeryStaffNurse,MurrayCallowayCountyHospital,Murray,Kentucky ALBERTOGOLDMAN,MD ClinicaGoldmanofPlasticSurgery,PortoAlegre,Brazil ROBERTH.GOTKIN,MD,FACS CosmetiqueDermatology,LaserandPlasticSurgery,LLP,NewYork,NewYork MARKS.GRANICK,MD ProfessorandChief,DivisionofPlasticSurgery,DepartmentofSurgery,NewJersey MedicalSchool—UMDNJ,Newark,NewJersey STEFANO.P.HOFER,MD,PhD,FRCS(C) WhartonChairinReconstructivePlasticSurgery;AssociateProfessor,Universityof Toronto;Chief,DivisionofPlasticSurgery,DepartmentsofSurgeryandSurgical Oncology,UniversityHealthNetwork,Toronto,Ontario,Canada ERIKA.HOY,BS MedicalStudent,NewJerseyMedicalSchool—UMDNJ,Newark,NewJersey DEBORAHS.HICKMANMATHIS,RN,MS,CNOR,RNFA RenuePlasticSurgery,RenueSurgeryCenter,Brunswick,Georgia MARCA.M.MUREAU,MD,PhD AssistantProfessorandHead,OncologicalReconstructiveSurgery,DepartmentofPlastic andReconstructiveSurgery,ErasmusUniversityMedicalCenter,Rotterdam, TheNetherlands THERESA(TESS)M.PAPE,PhD,RN,CNOR AssociateProfessor,TexasWoman’sUniversityCollegeofNursing,Denton,Texas iv Contributors JUDITHSELTZER,MS,BSN,RN,CNOR MolnlyckeHealthCare,Fallston,Maryland PAIGETELLER,MD DepartmentofSurgicalOncology,EmoryUniversity,Atlanta,Georgia MARYTSCHOI,MD Resident,DivisionofPlasticSurgery,DepartmentofSurgery,NewJerseyMedical School—UMDNJ,Newark,NewJersey THERESEK.WHITE,MD,FACS PlasticandHandSurgicalAssociates,SouthPortland,Maine PlasticandReconstructiveSurgery Contents Preface:PlasticandReconstructiveSurgery,AmbulatoryandInpatient ix DeborahS.HickmanMathis TheRoleofDistractionsandInterruptionsinOperatingRoomSafety 101 Theresa(Tess)M.Pape The Institute of Medicine provided the impetus for error awareness in health care organizations with its landmark study of 1999. Since then, societal pressures have increased the momentum for improvements in patientsafety.Perioperativeerrorsareoftentheresultofsystemproblems instead of people problems. These can lead to patient injury, increased hospitalcosts,andblamingothers.Theerrorconcernsintheperioperative settinginclude:distractions,interruptions,lackoffocus,poorcommunica- tion,andfailuretofollowstandardprocedures.Allofthiscanmakeforan unsafeenvironmentforpatients.Understandingtheroleoftheseissuesin termsofhumanfactorapproachesmayprovidetheimpetusforinterven- tionsthatpromoteerrorprevention.Humanfactorsandscienceandsafety strategiesborrowedfromaviationaredescribedinanefforttoshedlight onwaystopreventerrorswithintheperioperativesetting. SkinAntisepsis:FirstLineofDefenseSetSkinPreparationinMotionBefore theIncision 113 JudithSeltzer Therearemultiplewaysinwhichskinpreparationcanbeaccomplished.In addition, with the number of skin preparation agents approved for use, nurses sometimes find themselves asking which skin preparation agent willprovidethebestefficacyforskindisinfection.Adoptingastandardized methodforselectingandapplyingthesurgicalskinpreparationmaybethe bestwaythesurgicalteamcandeterminethatallpatientsarereceivingthe samestandardofcare,thuspromotingbestoutcomesintheirfightagainst surgical-siteinfections. SpecialConsiderationsinHistoryandPhysicalAssessmentofthePlastic, Cosmetic,andReconstructiveSurgeryPatient 125 AndreaFassiotto One of the most important tasks of the perioperative nurse is to obtain a thorough history and physical assessment before surgery. The nurse shouldbeabletoassessthepatient,obtainahistoryofthepatient,and observeforanypotentialproblems. Laser-AssistedLiposuction 131 AlbertoGoldmanandRobertH.Gotkin IntheUnitedStates,asinmanyothercountries,liposuctionisthemostcom- monly performed cosmetic surgical procedure. Advances in technology vi Contents haveenabledsurgeonstoimprovethesafetyandefficacyoftheprocedure. Onesuchtechnologicaladvanceislaser-assistedliposuction.Thisminimally invasive technique employs laser energy in direct contact with adipose tissuetoinducelipolysisand,atthesametime,coagulatetinybloodvessels andstimulatedermalandsubdermalneocollagenesis.Thesefeaturesofla- serlipolysispermitafast,comfortablepostoperativerecovery,arapidreturn toactivitiesofdailyliving,andexcellentskinredrapingasaresultoflaser- inducedskintightening. ImprovingOutcomesinAestheticFacialReconstruction 147 StefanO.P.HoferandMarcA.M.Mureau Aestheticfacialreconstructionisachallengingart.Improvingoutcomesin aesthetic facial reconstruction requires a thorough understanding of the basic principles of the functional and aesthetic requirements for facial reconstruction.Fromthere,furtherrefinementandattentiontodetailcan be provided. This article discusses basic principles of aesthetic facial reconstruction. ThePhysiologyofWoundHealing:InjuryThroughMaturation 159 PaigeTellerandThereseK.White Wound healing has evolved from a science of clinical observation to astudyofmolecularbiologyandcellularphysiology.Thisarticlewillreview themedicalliteraturetoprovideabasisforunderstandingthecurrentsci- enceofwoundhealing. SkinFlaps 171 MaryTschoi,ErikA.Hoy,andMarkS.Granick Openwounds,particularlyaroundtheface,oftenrequirecomplicatedtech- niquesforoptimalclosure.Theapproachtotheclosureofthecomplicated wounddependslargelyonthenatureofthewound,includingthelocation andsizeofthedefect,thefunctionaloutcomeafterclosure,themedicalco- morbiditiesofthepatient,neighboringstructures,andwhetherthedefectis secondarytoamalignancyortrauma.Thegoalsofwoundmanagementare optimalaestheticoutcome,preservationoffunction,andpatientsatisfac- tion. The authors briefly review basic skin closure options and discuss useofskinflaps,particularlyoftheheadandneckregion. TheCultureofSafety 187 DeborahS.HickmanMathis FollowingtheInstituteforHealthcareImprovement’slaunchofthe100,000 Lives Campaign, a national effort to reduce preventable deaths in U.S. hospitals began. No one could have imagined the strength of the re- sponse. Anextraordinaryresurgenceofspiritandanunprecedentedcom- mitment to change and collaboration across the health care industry evolved.Thisarticle discussesaprogramthatcame outofthateffortat RenuePlasticSurgery,afree-standingplastic/cosmetic andreconstruc- tiveambulatorysurgerycenter. Index 195 PlasticandReconstructiveSurgery vii FORTHCOMING ISSUES RECENT ISSUES September2011 March2011 Robotics FootandAnkleSurgery JohnZender,RN,BS,CNOR, ThomasZgonis,DPM,FACFAS, GuestEditor GuestEditor December2011 December2010 CollaborativeCareinFacialInjury InfectionPreventioninthePerioperative VivekShetty,MD,and Setting:ZeroToleranceforInfections GrantN.Marshall,MD, GeorgeAllen,RN,PhD,MS, GuestEditors BSN,CIC,CNOR, GuestEditor March2012 CultureofSafety September2010 JulieThompson,RN, SterilizationandDisinfectionforthe GuestEditor PerioperativeNurse TerriGoodman,PhD,RN,CNOR, June2012 GuestEditor BurnCareUpdate PatFortner,LTC, GuestEditor THE CLINICS ARE NOW AVAILABLE ONLINE! Accessyoursubscriptionat: www.theclinics.com Thispageintentionallyleftblank PlasticandReconstructiveSurgery Preface Plastic and Reconstructive Surgery, Ambulatory and Inpatient DeborahS.HickmanMathis,RN,MS,CNOR,RNFA GuestEditor Plasticandreconstructivesurgery,wound,andhandcontinuetobethefocusofplastic surgerypractices,plasticandreconstructivesurgerycenters,acutecaredepartmental entities, as well as some nontraditional cosmetic spas/facilities. Plastic and recon- structivesurgerywillaffectmostpeopleatsomepointintheirortheirlovedones’lives. This specialty serves all areas of the body ranging from cosmetic, to restorative, corrective, and functional, to multidisciplinary collaborative procedures. It is the purpose of this issue of Perioperative Nursing Clinics to address a few of the many topics facing those in the practice of plastic and reconstructive surgery and those interdepartmental entities that serve the patient collaboratively for the best outcome possibleintheprovisionoftheirhealthcare.Below,youwillfindthenames,contact information, and mission statements of some of the professional organizations that supporttheprovisionofplasticandreconstructiveprofessionalpractice. The mission statement of the American Board of Plastic Surgery, Inc (based in Philadelphia, PA, USA; https://www.abplsurg.org/moddefault.aspx) is to promote safe, ethical, efficacious plastic surgery to the public by maintaining high standards fortheeducation,examination,certification,andmaintenanceofcertificationofplastic surgeonsasspecialistsandsubspecialists. TheAmericanSocietyforAestheticPlasticSurgery(ASAPS),foundedin1967,isthe leadingprofessionalorganizationofplasticsurgeonscertifiedbytheAmericanBoard ofPlasticSurgerywhospecializesincosmeticplasticsurgery.With2600membersin the United States, Canada, and many other countries, ASAPS is at the forefront of innovation in aesthetic plastic surgery around the world (http://www.plasticsurgery. org/). The mission of ASAPS is to advance quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice, and research in plastic surgery. The society advocates for patient safety, such as requiring its PerioperativeNursingClinics6(2011)ix–xi doi:10.1016/j.cpen.2011.04.004 periopnursing.theclinics.com 1556-7931/11/$–seefrontmatter(cid:2)2011ElsevierInc.Allrightsreserved.