Total quality management in plastic surgery.

BACKGROUND: Quality management in plastic surgery has been limited to audit reports of individual clinical conditions, procedures and their outcomes, mortality rates, or other individual aspects of the field. METHODS: This work was done as a part of the mission assigned to us from the Military Medical Directorate to work on and develop the policies and standards of the practice of plastic surgery in the Saudi military hospitals. It is an overview of auditing in plastic surgery with a new expansion vision of the concept of total quality management in plastic surgery including the executable component (new data collection forms) that leads to the complete quality cycle. In addition, a pilot study over one of the main referral units of the military hospitals, Riyadh Armed Forces Hospital, is included. RESULTS: The various suggested audit and the monthly report forms are presented. The study of the unit revealed that the most frequently operated region was the head and neck, followed by the hand. Major operations constituted 31.3% of the surgeries done, and there was an overall negative correlation between age and hospital stay. CONCLUSIONS: A general approach and unifying the auditing process facilitates comparisons between departments in the same country and between different countries in the globe.

Retrospective analysis of secondary alveolar cleft grafts using iliac of chin bone.

The osseous closure of alveolar clefts is an integral component of a comprehensive rehabilitation of patients with cleft lip and palate and has assumed an essential position in the reconstruction of cleft deformity. Our study consists of 35 patients aged between 7 and 11 years who received secondary bone grafting of their cleft alveolus over a 30 month period from July 1999 to December 2003. There were 22 (62.9%) males and 13 (37.1%) females. In 25 cases, bone graft was harvested from the iliac crest and in 10 others, from the mandibular symphysis. A total number of 41 osteoplasties was performed in the 35 patients. Twenty osteoplasties maintained an alveolar height up to 75% and approximately that number showed resorption varying between 50% and 75%. There was no case of complete resorption of graft. There were no serious periodontal pockets found. In all cases, the wound healed well, and there was no complication. Our experience demonstrates that secondary alveolar bone grafting is an efficacious method of rehabilitating patients with alveolar clefts.

Pediatric myoepithelioma of the palate.

Myoepithelioma is a rare benign tumor. There are controversial subtypes that lack myogenic differentiation. A 2003 literature search listed only 12 cases of myoepithelioma of the maxillofacial region. This paper describes one case of pediatric myoepithelioma as an addition to the previously documented cases, and a review of the literature.

Laparoscopic treatment of hepatic hydatid cysts with a liposuction device.

OBJECTIVE: We describe herein a surgical technique, whereby we use a liposuction device for the laparoscopic treatment of hepatic hydatid cysts (HHC). METHODS: Ten patients with 12 hepatic hydatid cysts were treated with this technique. All patients received pre- and postoperative antiscolecidal medications. The laparoscopic technique consisted of partial aspiration of the cyst fluid and replacement of the aspirated fluid with 10% Betadine. The Betadine solution was left in situ for 10 minutes. Evacuation of the cyst contents was carried out with the liposuction device. The residual cavity was unroofed by partial excision of the ectocyst. A drain was left alongside the cyst. No intra- or postoperative complications were encountered. RESULTS: All patients were mobilized freely, were allowed to eat a regular meal 6 hours after recovery from anesthesia, and were discharged on the third postoperative day. All patients resumed their normal household and work activities by the tenth postoperative day. The patients were regularly followed up every 2 months for 2 years. At follow-up in the surgical clinic, no evidence of recurrence was noted either clinically, serologically, or by imaging techniques. CONCLUSION: We conclude that the laparoscopic treatment of HHC is feasible and advantageous. We believe that the use of a liposuction device facilitates rapid and efficient evacuation of the viscid organic contents of the cyst and helps in the obliteration of the residual cavity.