114 - CHEST WALL CONTOURING IN FEMALE-TO-MALE TRANSSEXUALS: OUR EXPERIENCE AND ALGORYTHM

Size: px
Start display at page:

Download "114 - CHEST WALL CONTOURING IN FEMALE-TO-MALE TRANSSEXUALS: OUR EXPERIENCE AND ALGORYTHM"

Transcription

1 114 - CHEST WALL CONTOURING IN FEMALE-TO-MALE TRANSSEXUALS: OUR EXPERIENCE AND ALGORYTHM VITTORIO RAMELLA (1) - GIOVANNI PAPA (1) - LUIGI TROISI (1) - FEDERICO CESARE NOVATI (1) - ALBERTO FRANCHI (1) - STEFANO BOTTOSSO (1) - ZORAN MARJI ARNEZ (1) AZIENDA OSPEDALI RIUNITI DI TRIESTE, OSPEDALE DI CATTINARA, TRIESTE, ITALIA (1) Chest wall contouring is the first step in sexual reassignment surgery in female-to-male transsexuals, often contextually with hysterectomy with bilateral salpingo-oophorectomy. There are three surgical technique that can be used: subcutaneous mastectomy with semi-circular technique, subcutaneous mastectomy with concentric circular technique and mastectomy with free nipple-areola complex graft. The objective of the study is analysing our experience in this type of surgery and evaluating the key factors for the selection of best technique. We analysed our series of chest wall contouring in order to develop an algorithm for the selection of the appropriate technique. We performed 116 chest wall contouring in 58 female-to-male transsexuals using all three the previous presented techniques. We analysed the patient data, the factors that guide the surgeon in the choice of the technique and the results. We performed 21 mastectomy with semicircular technique, 9 mastectomy with concentric circular technique and 86 mastectomy with free nipple-areola graft. The choice was performed considering many factors. In our experience, the key factors are the breast size, the grade of ptosis and the position and size of the nipple-areola complex. Applying this algorithm, the patient satisfaction was high and the need of a re-intervention was low. Breast size, grade of ptosis and the position and size of the nipple-areola complex are the key factors in choosing the appropriate technique.

2 122 - A SIMPLE AND EFFECTIVE PROTOCOL FOR MICROSURGICAL VASCULAR TRAINING DURING RESIDENCY: A STARWAY TO HEAVEN LONG-LASTING 3 WEEKS! LUIGI ANNACONTINI (1) - MONICA RUCCI (1) - MICHELA CAMPANARO (1) - LUIGI CAGIANO (1) - ROBERTO CECCHINO (1) - DOMENICO PARISI (1) - AURELIO PORTINCASA (1) CHIRURGIA PLASTICA RICOSTRUTTIVA ED ESTETICA, AZIENDA OSPEDALIERO UNIVERSITARIA OORR FOGGIA/ UNIVERSITÀ DI FOGGIA, FOGGIA, ITALIA (1) INTRODUCTION: Microsurgery prove how fine and accurate could be reconstructive procedure after oncological demolitions, traumas or in congenital malformations. Thanks to appropriate training, instruments, magnification and suturing material, the microsurgeon can carefully manipulate vessels and nerves. The Authors present their training model in microvascular techniques on laboratory rats. MATERIAL & METHOD: We refer on Residents training in Lab with TT anastomose on femoral artery and femoral vein graft vs femoral artery. It lasts 3 weeks, under a tutor supervision. Basic training foresee 15 Wistar rats for each technique which means 30 TT anastomoses on femoral artery and 15 femoral vein vs femoral artery grafts. A mixture of ketamine and xylazine is used for anesthesia. They used the Carrel technique. Success rate both for TT suture and vein graft pass from 0-20% in the first week to % in the last week. In 3 weeks suturing confidence raise from 120 to 40 min for TT suture and from 180 to 50 min in vein grafting. After this the resident can be involved as assistant in microsurgical procedures. It is not possible to codify how long the Training in Microsurgery should be. A constant working in the Lab represent an imperative starting point. Individual predisposition and motivation represent fundamental elements for the continuing in the study and practice of this branch. A fine technique is the result of years of practice. For Microsurgery: pre-operative planning, dedicated operation theatre, dedicated instruments and an Equipe in harmony are mandatory for success.

3 123 - MODIFIED ABBÈ FLAP FOR LIP RECONSTRUCTION MICHELA CAMPANARO (1) - JUAN MANUEL MARQUEZ CAŃADA (2) - LUIGI ANNACONTINI (1) - MONICA RUCCI (1) - LUIGI CAGIANO (1) - DOMENICO PARISI (1) - AURELIO PORTINCASA (1) CHIRURGIA PLASTICA RICOSTRUTTIVA ED ESTETICA, AZIENDA OSPEDALIERO UNIVERSITARIA OORR FOGGIA/ UNIVERSITÀ DI FOGGIA, FOGGIA, ITALIA (1) - HOSPITAL CLINICO, HOSPITAL CLINICO, VALENCIA, SPAGNA (2) Lips reconstruction is one of the hardest procedures in the head and neck reconstruction. The first goal is to achieving a complete restoration of its function, such as oral competence, muscle function, sensation and oral gape. We dived the defects of the upper lip in three kinds, according of the amount of tissue to restore: only vermilion, vermilion plus cutaneous defect, or previous two plus mucosa defect. When all these tissues are involved, the classical ABBE flap and its modifications already published, led to good functional restoration, without an adequate aesthetic result. Murray improved the aesthetic result of this technique with the use of skin grafts in combination with columella advancement flaps and vermilion rotation. We present a modification of the ABBE-Standler flap for upper lip reconstruction including a superior mucosa-vermilion bilateral prolongation and an inferior bilateral prolongation of the skin. Our goal is to increase de volume and projection of the upper lip. The technique includes two stages. The first one for the elevation and insetting of the flap, the second one for cutting the pedicle and the final insetting. With a period of 3 weeks between them. Postoperative follow up included daily visits during the first week, and each week until one month 3 weeks after the second surgery, the upper lip is projected with a noticeable increase of the volume. There were no complications. Preserved sensibility. The patient is able to smile, kiss and flow with an optimal mouth opening. Moreover the patient reports an improvement of his self-esteem, and has started to increase his social life. We present a double extended abbe flap Laying H flap that solves the restoration of lip defects, projection and white lip length, providing improved results in the upper lip reconstruction both in aesthetic and functional restoration.

4 129 - COMPLEX THORACO-ABDOMINAL RECONSTRUCTIONS GIANPAOLO FAINI (1) U.C. CHIRURGIA PLASTICA E RICOSTRUTTIVA, AZIENDA OSPEDALIERA SPEDALI CIVILI DI BRESCIA, BRESCIA, ITALIA (1) The Author presents three clinical cases in which the use of microsurgery has been considered mandatory in order to obtain a complete resolution. Between July 2014 and March 2015, 3 patients have undergone microsurgical reconstruction for coverage of loss of substance respectively in the thoracic region (subclavian artery prosthesis exposure), thoracic region (resection of clavicular osteosarcoma) and thoraco-abdominal region (resection of myosarcoma). The recipient vessels have been in 2 cases the internal mammary vessels and in one case the deep inferior epigastric artery. The flap used were 2 vertical rectus abdomis miocutaneous flap and 1 muscular latissimus dorsi flap. The post-operative period has been uneventful for all the three patients with complete survival of the flaps. In all the three cases a stable coverage has been achieved. In some particular cases it is not possible to obtain a stable and valid reconstruction and coverage of the thoracic and abdominal regions with the sole use of local flaps, neither with the use of perforator propeller flaps, due to the extent of the defect or for the impossibility to use loco regional options. In these circumstances the use of microsurgical technique allows to obtain a valid and stable coverage with long term results and relative morbidity.

5 130 - USE OF PEDICLED AND MICROSURGICAL PERFORATOR FLAPS FOR RECONSTRUCTION OF VARIOUS ANATOMICAL REGIONS: A SINGLE-SURGEON OPERATIVE CASES ANALYSIS GIANPAOLO FAINI (1) - ALESSANDRA SCAINI (1) - PAOLO PANDOLFI (1) U.C. CHIRURGIA PLASTICA E RICOSTRUTTIVA, AZIENDA OSPEDALIERA SPEDALI CIVILI DI BRESCIA, BRESCIA, ITALIA (1) The Author presents his clinical and surgical experience regarding the use of pedicled and microsurgical perforator flaps, analyzing success and failure rate, and complications. This case series has also been compared with the available Literature. From March 2011 to May (87,5%) pedicled and 8 (12,5%) microsurgical perforator flaps have been raised. This case series is single-surgeon and corresponds to the totality of the perforator flaps performed in our Division. The only inclusion criteria considered has been the use of a perforator flap. The etiology of the clinical cases varied from traumatic, oncologic, actinic damage and loss of substance secondary to pressure sores. This cases series includes the reconstruction of all anatomical areas of the body This series presents a 90,6% of complete success rate with the achievement of a stable and valid reconstruction. The failure rate is of 9,4% with the complete loss of 6 flaps. 13 of 64 flaps (20,3%) presented complications, treated conservatively in 4 cases. Among all the results, that will be discussed in the presentation, it is of a certain importance the decrease of overall failure rate of this surgery, ranging from 20% of in 2011 to 4% in Our case series matches the results of the other surgical case series presented in International Literature. It is also possible to infere a progressive temporal decrease of complications and failure rate, for both pedicle and microsurgical flaps, due to the learning curve of the single operator.

SCOPE OF PRACTICE PGY-6 PGY-7 PGY-8

SCOPE OF PRACTICE PGY-6 PGY-7 PGY-8 PGY-6 Round on all plastic surgery inpatients every day. Assess progress of patients and identify real or potential problems. Review patients progress with attending physicians daily and participate in

More information

Chapter 24. Evolution of Procedures

Chapter 24. Evolution of Procedures Chapter 24 BREAST SURGERY KEY FIGURES: Saline implant reconstruction Latissimus dorsi reconstruction Free TRAM reconstruction In the developed world, breast reconstruction after mastectomy and breast reduction

More information

The spectrum of breast surgery

The spectrum of breast surgery The spectrum of breast surgery at SCPMG Cissy Tan, M.D. Regional Chief of Plastic Surgery, SCPMG Breast/Mastectomy Reconstruction Breast reduction Management of breast implant problems Gynecomastia 1 Breast

More information

Breast Implants and Reconstruction

Breast Implants and Reconstruction Last Review Date: October 9, 2015 Number: MG.MM.SU.fv2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth

More information

Medical Policy Original Effective Date: 11-19-08 Revised Date: 1-27-16 Page 1 of 8

Medical Policy Original Effective Date: 11-19-08 Revised Date: 1-27-16 Page 1 of 8 Page 1 of 8 Disclaimer Description Coverage Determination Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans, or the plan

More information

Breast Reconstruction Options. Department of Plastic Surgery #290 Santa Clara Homestead Campus

Breast Reconstruction Options. Department of Plastic Surgery #290 Santa Clara Homestead Campus Breast Reconstruction Options Department of Plastic Surgery #290 Santa Clara Homestead Campus Importance of Breast Reconstruction As successes in treating breast cancer have grown, more women have been

More information

Breast Reconstruction Frequently Asked Questions

Breast Reconstruction Frequently Asked Questions Breast Reconstruction Frequently Asked Questions GENERAL Do I need to have breast reconstruction? It is never medically necessary to have breast reconstruction. This is considered an elective procedure,

More information

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY

OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY OPEN ACCESS ATLAS OF OTOLARYNGOLOGY, HEAD & NECK OPERATIVE SURGERY NASOLABIAL FLAP FOR ORAL CAVITY RECONSTRUCTION Harry Wright, Scott Stephan, James Netterville Designed as a true myocutaneous flap pedicled

More information

Plastic and Reconstructive Surgery

Plastic and Reconstructive Surgery Plastic and Reconstructive Surgery General Description Office for Clinical Affairs (515) 271-1629 FAX (515) 271-1727 Elective Rotation This elective rotation in Plastic and Reconstructive Surgery (PRS)

More information

Breast Reconstruction Surgery

Breast Reconstruction Surgery Breast Reconstruction Surgery I. Policy University Health Alliance (UHA) will reimburse for Breast Reconstruction Surgery when it is determined to be medically necessary and when it meets the medical criteria

More information

PLASTIC SURGERY RESIDENTS HANDBOOK

PLASTIC SURGERY RESIDENTS HANDBOOK PLASTIC SURGERY RESIDENTS HANDBOOK I. PLASTIC SURGERY REQUIREMENTS a. AACPS Post Interview Communication Guidelines b. General Competencies c. Plastic Surgery Goals & Objectives d. ACGME Required Index

More information

Lip Cancer: Treatment & Reconstruction

Lip Cancer: Treatment & Reconstruction Lip Cancer: Treatment & Reconstruction GBMC - Head & Neck Cancer Grand Rounds Elizabeth E. Redd, M.D. With the assistance of Ira Papel, M.D. Patrick Byrne, M.D. Lip Cancer: Treatment & Reconstruction Anatomic

More information

Specific Standards of Accreditation for Residency Programs in Plastic Surgery

Specific Standards of Accreditation for Residency Programs in Plastic Surgery Specific Standards of Accreditation for Residency Programs in Plastic Surgery INTRODUCTION 2008 The purpose of this document is to provide program directors and surveyors with an interpretation of the

More information

BREAST RECONSTRUCTION POST MASTECTOMY

BREAST RECONSTRUCTION POST MASTECTOMY BREAST RECONSTRUCTION POST MASTECTOMY CLINICAL POLICY Policy Number: SURGERY 095.11 T2 Effective Date: January 1, 2016 Table of Contents CONDITIONS OF COVERAGE... BENEFIT CONSIDERATIONS... COVERAGE RATIONALE...

More information

PLASTIC & RECONSTRUCTIVE SURGERY REFERRAL AND CONSULTATION GUIDE 2011-2012

PLASTIC & RECONSTRUCTIVE SURGERY REFERRAL AND CONSULTATION GUIDE 2011-2012 PLASTIC & RECONSTRUCTIVE SURGERY REFERRAL AND CONSULTATION GUIDE 2011-2012 Table of Contents Services & Resources... 1 Specialties Breast Reconstruction Surgery... 2 Burn and Complex Wound Care... 3 Craniofacial

More information

CURRICULUM VITAE. Fabrizio Schonauer. Place, date of birth: Naples, Italy, October 4th, 1967

CURRICULUM VITAE. Fabrizio Schonauer. Place, date of birth: Naples, Italy, October 4th, 1967 CURRICULUM VITAE Name: Fabrizio Schonauer Place, date of birth: Naples, Italy, October 4th, 1967 Degrees: 1) Degree in Medicine and Surgery, University "Federico II", Naples summa cum laude, 1991 2) Specialization

More information

Breast Reconstruction Following Mastectomy or Lumpectomy

Breast Reconstruction Following Mastectomy or Lumpectomy Breast Reconstruction Following Mastectomy or Lumpectomy [For the list of services and procedures that need preauthorization, please refer to www.mcs.pr Go to Comunicados a Proveedores, and click Cartas

More information

APPENDIX D. April 1, 2015 AD1 Amd 12 Draft 1. Appendix DApril 1, 2015 PREAMBLE

APPENDIX D. April 1, 2015 AD1 Amd 12 Draft 1. Appendix DApril 1, 2015 PREAMBLE Appendix DApril 1, 2015 PREAMBLE 1. Surgery to alleviate significant physical symptoms, which have not responded to a minimum of six months active treatment, or to restore or improve function to any area

More information

Minimally Invasive Spine Surgery

Minimally Invasive Spine Surgery Chapter 1 Minimally Invasive Spine Surgery 1 H.M. Mayer Primum non nocere First do no harm In the long history of surgery it always has been a basic principle to restrict the iatrogenic trauma done to

More information

Reshaping You. Breast Reconstruction for Breast Cancer Patients

Reshaping You. Breast Reconstruction for Breast Cancer Patients Reshaping You Breast Reconstruction for Breast Cancer Patients Foreword Women diagnosed with breast cancer begin a journey that requires making health care decisions that can have profound effects on their

More information

Introduction There are two approved residency training models for plastic surgery, the Independent Model and the Integrated Model.

Introduction There are two approved residency training models for plastic surgery, the Independent Model and the Integrated Model. TRAINING REQUIREMENTS Introduction There are two approved residency training models for plastic surgery, the Independent Model and the Integrated Model. A plastic surgery program director may choose to

More information

BREAST RECONSTRUCTION POST MASTECTOMY

BREAST RECONSTRUCTION POST MASTECTOMY COVERAGE DETERMINATION GUIDELINE BREAST RECONSTRUCTION POST MASTECTOMY Guideline Number: CDG.003.05 Effective Date: January 1, 2016 Table of Contents COVERAGE RATIONALE... DEFINITIONS... APPLICABLE CODES...

More information

Breast Reconstruction. What You Should Know

Breast Reconstruction. What You Should Know Breast Reconstruction What You Should Know M astectomy for treating breast cancer is the most common reason that women have breast reconstruction. In fact, the number of women undergoing this reconstructive

More information

Laparoscopic hernia repair GEORGIOS SAMPALIS GENERAL SURGEON. Director of surgical department of Lefkos Stavros of Athens

Laparoscopic hernia repair GEORGIOS SAMPALIS GENERAL SURGEON. Director of surgical department of Lefkos Stavros of Athens Laparoscopic hernia repair GEORGIOS SAMPALIS GENERAL SURGEON Director of surgical department of Lefkos Stavros of Athens About 600,000 surgical hernia repair procedures are performed every year... Many

More information

Oncoplastic breast surgery e A guide to good practice

Oncoplastic breast surgery e A guide to good practice EJSO 33 (2007) S1eS23 www.ejso.com Oncoplastic breast surgery e A guide to good practice On behalf of the Association of Breast Surgery at BASO, BAPRAS and the Training Interface Group in Breast Surgery*

More information

Integumentary System Individual Exercises

Integumentary System Individual Exercises Integumentary System Individual Exercises 1. A physician performs an incision and drainage of a subcutaneous abscess in his office for a particularly uncooperative established patient. How should this

More information

Address Via Morano 21 10023 CHIERI (TORINO) - ITALY

Address Via Morano 21 10023 CHIERI (TORINO) - ITALY Anagraphic data Family name: BATTISTON First name: BRUNO Date of birth: 15/01/1960 Place of birth: TORINO Medicine Degree in Torino University Medical School cum laude on 1984 (Thesis on osteochondritis

More information

PLASTIC SURGERY PROFILE

PLASTIC SURGERY PROFILE PLASTIC SURGERY PROFILE GENERAL INFORMATION (Source: Pathway Evaluation Program and Royal College) Plastic surgery includes the management of major burns, reconstruction of congenital malformations, cosmetic

More information

Tissue Reinforcement with Strattice Reconstructive Tissue Matrix following Correction of Severe Breast Deformity

Tissue Reinforcement with Strattice Reconstructive Tissue Matrix following Correction of Severe Breast Deformity Tissue Reinforcement with Strattice Reconstructive Tissue Matrix following Correction of Severe Breast Deformity Robert Cohen, MD, FACS* Paradise Valley, AZ Case summary A 41-year old woman with a history

More information

INTERNATIONAL MEDICAL COLLEGE

INTERNATIONAL MEDICAL COLLEGE INTERNATIONAL MEDICAL COLLEGE Joint Degree Master Program: Implantology and Dental Surgery (M.Sc.) Basic modules: List of individual modules Basic Module 1 Basic principles of general and dental medicine

More information

Clinical Privileges Profile Plastic Surgery. Indu & Raj Soin Medical Center

Clinical Privileges Profile Plastic Surgery. Indu & Raj Soin Medical Center Printed Name Clinical Privileges Profile Plastic Surgery Indu & Raj Soin Medical Center Applicant: Check off the Requested box for each privilege requested. Applicants have the burden of producing information

More information

KCE REPORT 251 AUTOLOGOUS BREAST RECONSTRUCTION TECHNIQUES AFTER MAMMARY RESECTION: TIME MEASUREMENTS FOR A POTENTIAL RE-EVALUATION OF THE SURGEON FEE

KCE REPORT 251 AUTOLOGOUS BREAST RECONSTRUCTION TECHNIQUES AFTER MAMMARY RESECTION: TIME MEASUREMENTS FOR A POTENTIAL RE-EVALUATION OF THE SURGEON FEE KCE REPORT 251 AUTOLOGOUS BREAST RECONSTRUCTION TECHNIQUES AFTER MAMMARY RESECTION: TIME MEASUREMENTS FOR A POTENTIAL RE-EVALUATION OF THE SURGEON FEE 2015 www.kce.fgov.be KCE REPORT 251 HEALTH TECHNOLOGY

More information

The role of microsurgical free flaps in distal tibia, ankle and foot reconstruction

The role of microsurgical free flaps in distal tibia, ankle and foot reconstruction 223 EEXOT Volume 59, (4):223-229, 2008 The role of microsurgical free flaps in distal tibia, ankle and foot reconstruction A 6 year experience N.I. KARMIRIS, S.Α. VOURTSIS, C.M. ASSIMOMITIS, P.K. SPYRIOUNIS

More information

Medical Policy Reconstructive Breast Surgery/Management of Breast Implants

Medical Policy Reconstructive Breast Surgery/Management of Breast Implants Medical Policy Reconstructive Breast Surgery/Management of Breast Implants Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References

More information

Basic techniques of pulmonary physical therapy (I) 100/04/24

Basic techniques of pulmonary physical therapy (I) 100/04/24 Basic techniques of pulmonary physical therapy (I) 100/04/24 Evaluation of breathing function Chart review History Chest X ray Blood test Observation/palpation Chest mobility Shape of chest wall Accessory

More information

Policy #: 111 Latest Review Date: January 2010

Policy #: 111 Latest Review Date: January 2010 Name of Policy: Co-surgeons and Team Surgeons Policy #: 111 Latest Review Date: January 2010 Category: Administrative Policy Grade: N/A Background: As a general rule, benefits are payable under Blue Cross

More information

INFORMATION ON COSMETIC AND RECONSTRUCTIVE SURGERY(S) SUR716.001

INFORMATION ON COSMETIC AND RECONSTRUCTIVE SURGERY(S) SUR716.001 INFORMATION ON COSMETIC AND RECONSTRUCTIVE SURGERY(S) SUR716.001 NOTE: The members contract should be reviewed. Contract language may vary regarding the definition of reconstructive services for different

More information

a guide to understanding facial palsy a publication of children s craniofacial association

a guide to understanding facial palsy a publication of children s craniofacial association a guide to understanding facial palsy a publication of children s craniofacial association a guide to understanding facial palsy this parent s guide to facial palsy is designed to answer questions that

More information

PANNICULECTOMY & BODY CONTOURING PROCEDURES

PANNICULECTOMY & BODY CONTOURING PROCEDURES COVERAGE DETERMINATION GUIDELINE PANNICULECTOMY & BODY CONTOURING PROCEDURES Guideline Number: CDG.014.05 Effective Date: December 1, 2015 Table of Contents COVERAGE RATIONALE... DEFINITIONS. APPLICABLE

More information

Practical Considerations for Perforator Flap Thinning Procedures Revisited

Practical Considerations for Perforator Flap Thinning Procedures Revisited Practical Considerations for Perforator Flap Thinning Procedures Revisited Theddeus OH Prasetyono, Kristaninta Bangun, Frank B Buchari, Putri Rezkini Division of Plastic Surgery, Department of Surgery,

More information

Joint Surgery/Thoracic Surgery Program Review Committees for Surgery and Thoracic Surgery

Joint Surgery/Thoracic Surgery Program Review Committees for Surgery and Thoracic Surgery I. Introduction Joint Surgery/Thoracic Surgery Program Review Committees for Surgery and Thoracic Surgery The Joint Surgery/Thoracic Surgery program is approved by both the American Board of Surgery (ABS)

More information

PLASTIC SURGERY RESIDENCY 3-year Training Programme Curriculum (For Dual Accreditation)

PLASTIC SURGERY RESIDENCY 3-year Training Programme Curriculum (For Dual Accreditation) PLASTIC SURGERY RESIDENCY 3-year Training Programme Curriculum (For Dual Accreditation) TRAINING GUIDE (A) INTRODUCTION has a wide scope including Reconstructive Microsurgery, Cleft and Craniofacial Surgery,

More information

UNDERSTANDING & CODING WITH MODIFIERS

UNDERSTANDING & CODING WITH MODIFIERS UNDERSTANDING & CODING WITH MODIFIERS -21 Prolonged Evaluation and Management When the service provided is prolonged or otherwise greater than that usually required for the highest level of service in

More information

Tuberous Breast: Clinical Evaluation and Surgical Treatment

Tuberous Breast: Clinical Evaluation and Surgical Treatment Tuberous Breast: Clinical Evaluation and Surgical Treatment 7 Giovanni Zoccali and Maurizio Giuliani Department of Health Sciences, Plastic, Reconstructive and Aesthetic Surgery Section, University of

More information

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Medical Expert: Breast Rotation Specific Competencies/Objectives 1.0 Medical History

More information

Autologous Fat Transfer for Cosmetic and Reconstructive Breast Augmentation

Autologous Fat Transfer for Cosmetic and Reconstructive Breast Augmentation ASERNIP S Australian Safety and Efficacy Register of New Interventional Procedures-Surgical Systematic Review Autologous Fat Transfer for Cosmetic and Reconstructive Breast Augmentation September 2010

More information

Minimally Invasive Hip Replacement through the Direct Lateral Approach

Minimally Invasive Hip Replacement through the Direct Lateral Approach Surgical Technique INNOVATIONS IN MINIMALLY INVASIVE JOINT SURGERY Minimally Invasive Hip Replacement through the Direct Lateral Approach *smith&nephew Introduction Prosthetic replacement of the hip joint

More information

The Distally Based Lesser Saphenous Venofasciocutaneous Flap for Ankle and Heel Reconstruction

The Distally Based Lesser Saphenous Venofasciocutaneous Flap for Ankle and Heel Reconstruction The Distally Based Lesser Saphenous Venofasciocutaneous Flap for Ankle and Heel Reconstruction Shao-Liang Chen, M.D., Tim-Mo Chen, M.D., Trong-Duo Chou, M.D., Shyi-Gen Chen, M.D., and Hsian-Jenn Wang,

More information

REACHING OUT THROUGH THE WEB MILAN BREAST CANCER CONFERENCE Webcast and residential. 23/26 june 2015

REACHING OUT THROUGH THE WEB MILAN BREAST CANCER CONFERENCE Webcast and residential. 23/26 june 2015 REACHING OUT THROUGH THE WEB MILAN BREAST CANCER CONFERENCE Webcast and residential 23/26 june 2015 Tuesday 23 rd June 7.30 Registration 7.45 Opening session: W. Audretsch (Breast Center, Dusseldorf),

More information

Note: For information related to the medical necessity criteria for mammaplasty procedures, see SURG.00086 Reduction Mammaplasty.

Note: For information related to the medical necessity criteria for mammaplasty procedures, see SURG.00086 Reduction Mammaplasty. Subject: Document#: Current Effective Date: 10/01/2008 Status: Revised Last Review Date: 08/28/2008 Description/Scope Reconstructive breast surgery refers to surgical procedures to rebuild the contour

More information

Welcome to the July 2012 edition of Case Studies from the files of the Institute for Nerve Medicine in Santa Monica, California.

Welcome to the July 2012 edition of Case Studies from the files of the Institute for Nerve Medicine in Santa Monica, California. Welcome to the July 2012 edition of Case Studies from the files of the Institute for Nerve Medicine in Santa Monica, California. In this issue, we focus on a 23-year-old female patient referred by her

More information

(English) NEXUS SPINE SPACER SYSTEM

(English) NEXUS SPINE SPACER SYSTEM (English) NEXUS SPINE SPACER SYSTEM INDICATIONS FOR USE NEXUS Spine Spacer System, a GEO Structure is indicated for use in the thoraco-lumbar spine (i.e., T1 to L5) to replace a diseased vertebral body

More information

DEPARTMENT OF SURGERY GENERAL SURGERY SECTION

DEPARTMENT OF SURGERY GENERAL SURGERY SECTION Privilege Request Form DIRECTIONS: This Privilege Request Form must accompany all initial applications for appointment to the General Surgery Section, Department of Surgery. Please indicate those privileges

More information

IMPLANT CONSENT FORM WHAT ARE DENTAL IMPLANTS?

IMPLANT CONSENT FORM WHAT ARE DENTAL IMPLANTS? IMPLANT CONSENT FORM WHAT ARE DENTAL IMPLANTS? Dental implants are a very successful and accepted treatment option to replace lost or missing teeth. A dental implant is essentially an artificial tooth

More information

Fat Injection to Correct Contour Deformities in the Reconstructed Breast

Fat Injection to Correct Contour Deformities in the Reconstructed Breast Fat Injection to Correct Contour Deformities in the Reconstructed Breast Scott L. Spear, M.D., Henry B. Wilson, M.D., and Michelle D. Lockwood, M.D. Washington, D.C. Background: A ten-year, single-surgeon

More information

What is a dental implant?

What is a dental implant? Chicago Implants - Dr Ivan Valcarenghi - Dental Implants In our office, getting one or more dental implants involves two phases: the surgical and restorative phases. Most often, the surgical phase is performed

More information

THE DECISION GUIDE TO BREAST RECONSTRUCTION

THE DECISION GUIDE TO BREAST RECONSTRUCTION THE DECISION GUIDE TO BREAST RECONSTRUCTION Breast reconstruction is the process of making a new breast after mastectomy (removal of the breast) for breast cancer treatment or prevention ( therapeutic

More information

Traumatic Primary Eyelid and Facial Laceration Repair. Riva Lee Asbell Philadelphia, PA

Traumatic Primary Eyelid and Facial Laceration Repair. Riva Lee Asbell Philadelphia, PA Traumatic Primary Eyelid and Facial Laceration Repair Riva Lee Asbell Philadelphia, PA I INTRODUCTION I always have to work a little harder when coding for traumatic eyelid and facial repairs. There is

More information

Abdominal Pedicle Flaps To The Hand And Forearm John C. Kelleher M.D., F.A.C.S.

Abdominal Pedicle Flaps To The Hand And Forearm John C. Kelleher M.D., F.A.C.S. Abdominal Pedicle Flaps To The Hand And Forearm John C. Kelleher M.D., F.A.C.S. Global-HELP Publications Chapter Eight: TECHNICAL REQUIREMENTS FOR FORMATION OF A TUBED PEDICLE FLAP Creating a tube pedicle

More information

AMERICAN SOCIETY OF PLASTIC SURGEONS YOUNG PLASTIC SURGEONS STEERING COMMITTEE. Lynn Jeffers, MD, Chair C. Bob Basu, MD, Vice Chair

AMERICAN SOCIETY OF PLASTIC SURGEONS YOUNG PLASTIC SURGEONS STEERING COMMITTEE. Lynn Jeffers, MD, Chair C. Bob Basu, MD, Vice Chair AMERICAN SOCIETY OF PLASTIC SURGEONS YOUNG PLASTIC SURGEONS STEERING COMMITTEE Eighth Edition 2012 Lynn Jeffers, MD, Chair C. Bob Basu, MD, Vice Chair Essentials for Students Workgroup Lynn Jeffers, MD

More information

Take Home Message What at the basic tenets of AWR? What are the basic technical aspects of each approach? Limitations and benefits of each approach.

Take Home Message What at the basic tenets of AWR? What are the basic technical aspects of each approach? Limitations and benefits of each approach. AWR: Endoscopic CST, Ramirez CST, Stoppa, Posterior CST: A Decision Analysis Michael J. Rosen MD, FACS Professor of Surgery Director, Cleveland Clinic Comprehensive Hernia Center Cleveland Clinic Foundation

More information

5 Upper eyelid blepharoplasty

5 Upper eyelid blepharoplasty 5 Upper eyelid blepharoplasty INSTRUMENTS Marking pen No. 15 scalpel blade Blade handle Castroviejo needle holder Castroviejo calipers 0.5 fixation forceps Westcott scissors 6-0 prolene suture Bovie cautery

More information

Spinal Arthrodesis Group Exercises

Spinal Arthrodesis Group Exercises Spinal Arthrodesis Group Exercises 1. Two surgeons work together to perform an arthrodesis. Dr. Bonet, a general surgeon, makes the anterior incision to gain access to the spine for the arthrodesis procedure.

More information

Plastic Surgery - Exceptional Referrals Patient Pathway April 2005

Plastic Surgery - Exceptional Referrals Patient Pathway April 2005 Patient Presentation Patient seeks exceptional procedure Clinical assessment: Psychology criteria (see Appendix 1) Exceptional physical criteria (see Appendix 2) Patient meets criteria Patient does not

More information

Medical Review Criteria Gender Reassignment Services

Medical Review Criteria Gender Reassignment Services Medical Review Criteria Gender Reassignment Services Effective Date: May 12, 2016 Subject: Gender Reassignment Services for Fully-Insured Transgender Subscribers and Dependents Policy: HPHC covers specific

More information

CHAPTER 9. Plastic and Reconstructive Surgery of the Breast

CHAPTER 9. Plastic and Reconstructive Surgery of the Breast CHAPTER 9 Plastic and Reconstructive Surgery of the Breast Augmentation Mammaplasty Silicone Facts Breast Examinations Mastopexy (Breast Lifting) Reduction Mammaplasty Breast Reconstruction Note: Prior

More information

Facial Paralysis and Reanimation Smile Surgery Jeffrey R. Marcus MD. Introduction:

Facial Paralysis and Reanimation Smile Surgery Jeffrey R. Marcus MD. Introduction: Facial Paralysis and Reanimation Smile Surgery Jeffrey R. Marcus MD 2007 Jeffrey R. Marcus MD Introduction: Facial paralysis can result from a variety of causes, and it can affect people at nearly any

More information

XXXXX File No. 108655-001 Petitioner v. Issued and entered this 28 th day of June 2010 by Ken Ross Commissioner ORDER I PROCEDURAL BACKGROUND

XXXXX File No. 108655-001 Petitioner v. Issued and entered this 28 th day of June 2010 by Ken Ross Commissioner ORDER I PROCEDURAL BACKGROUND STATE OF MICHIGAN DEPARTMENT OF ENERGY, LABOR & ECONOMIC GROWTH OFFICE OF FINANCIAL AND INSURANCE REGULATION Before the Commissioner of Financial and Insurance Regulation In the matter of XXXXX File No.

More information

Harvesting Fat from the Infratemporal Fossa

Harvesting Fat from the Infratemporal Fossa Techniques in Cosmetic Surgery Harvesting Fat from the Infratemporal Fossa Bahman Guyuron, M.D., and Kevin Rose, M.D. Cleveland, Ohio As part of forehead rejuvenation and surgical treatment of migraine

More information

Breast reduction surgery

Breast reduction surgery Pan Manchester Patient Information Service July 2007 Plastic Surgery Department Issue 2 BSBR Pan Manchester Plastic Surgery Services Department of Plastic Surgery Acknowledgement: Written by Mr P Kumar,

More information

Dr. Justin B. Maxhimer, M.D. Boulder Plastic Surgery: 303-443-2277. IV Seasons Skin Care: 303-938-1666 www.boulderplasticsurgery.

Dr. Justin B. Maxhimer, M.D. Boulder Plastic Surgery: 303-443-2277. IV Seasons Skin Care: 303-938-1666 www.boulderplasticsurgery. Dr. Hans R. Kuisle, M.D., F.A.C.S Dr. Winfield Hartley, M.D., F.A.C.S Dr. Justin B. Maxhimer, M.D. 2525 4 th Street, Suite 200, Boulder, CO 80304 Boulder Plastic Surgery: 303-443-2277 IV Seasons Skin Care:

More information

Cosmetic Surgery: Liposuction (Lipoplasty)

Cosmetic Surgery: Liposuction (Lipoplasty) This is a guide for people who are considering having a Liposuction operation. We advise that you talk to a plastic surgeon and only use this information as a guide to the procedure. Also known as Lipoplasty,

More information

What You Need to Know About Breast Reconstruction Surgery

What You Need to Know About Breast Reconstruction Surgery Millard Fillmore Suburban Hospital A Kaleida Health Facility What You Need to Know About Breast Reconstruction Surgery This packet of information contains choices that are available to you regarding breast

More information

Bone Anchored Hearing Aids B.A.H.A

Bone Anchored Hearing Aids B.A.H.A Bone Anchored Hearing Aids B.A.H.A Dr. Abdulrahman Hagr MBBS FRCS(c) Assistant Professor King Saud University Otolaryngology Consultant Otologist, Neurotologist & Skull Base Surgeon King Abdulaziz Hospital

More information

Chapter 33. Nerve Physiology

Chapter 33. Nerve Physiology Chapter 33 NERVE AND VASCULAR INJURIES OF THE HAND KEY FIGURES: Digital nerve location on finger Epineurial repair Nerves and blood vessels of the hand and fingers usually are quite delicate, and some

More information

DETROIT MEDICAL CENTER DEPARTMENT OF PEDIATRIC SURGERY DELINEATION OF PRIVILEGES IN PEDIATRIC PLASTIC SURGERY

DETROIT MEDICAL CENTER DEPARTMENT OF PEDIATRIC SURGERY DELINEATION OF PRIVILEGES IN PEDIATRIC PLASTIC SURGERY DETROIT MEDICAL CENTER DEPARTMENT OF PEDIATRIC SURGERY DELINEATION OF PRIVILEGES IN PEDIATRIC PLASTIC SURGERY QUALIFICATIONS: Effective July 1, 2009, all new applicants to the DMC will be required to be

More information

Loma Linda University Medical Center Loma Linda, CA 92354

Loma Linda University Medical Center Loma Linda, CA 92354 Name: Page 1 of 6 REQUEST CATEGORY MEMBERSHIP CATEGORY Provisional (Bylaws 4.3) Administrative (Bylaws 4.7) Affiliate (Bylaws(4.9) Active (Bylaws 4.2) Courtesy (Bylaws 4.4) Consulting (Bylaws 4.5) All

More information

Plastic surgery. Practice area 157. Background

Plastic surgery. Practice area 157. Background Practice area 157 Clinical PRIVILEGE WHITE PAPER Plastic surgery Background According to the American College of Surgeons (ACS), plastic surgery encompasses the repair, reconstruction, or replacement of

More information

Breast Augmentation. If you are dissatisfied with your breast size, augmentation surgery is a choice to consider. Breast augmentation can:

Breast Augmentation. If you are dissatisfied with your breast size, augmentation surgery is a choice to consider. Breast augmentation can: Breast Augmentation What is Breast Augmentation? Also known as augmentation mammaplasty, breast augmentation involves using implants to fulfill your desire for fuller breasts or to restore breast volume

More information

Breast Reconstruction Surgery

Breast Reconstruction Surgery Breast Reconstruction Surgery Breast Cancer Centre of Hope Breast Cancer Navigator 204-788-8080 Toll-free in Manitoba1-888-660-4866 Types of mastectomies Steps of breast reconstruction Breast reconstruction

More information

Facial Plastic and Reconstructive Surgery Service Educational Goals

Facial Plastic and Reconstructive Surgery Service Educational Goals Facial Plastic and Reconstructive Surgery Service Educational Goals 1. First-Year Resident (PGY-2) I. Knowledge Goals. Upon completion of this rotation the PGY-2 resident will have basic knowledge of the

More information

Sandwich technique of closure of lumbar hernia: A novel technique

Sandwich technique of closure of lumbar hernia: A novel technique CASE SERIES 243 OPEN ACCESS Sandwich technique of closure of lumbar hernia: A novel technique Manash Ranjan Sahoo, Anil Kumar T ABSTRACT Background: Lumbar hernia is a rare hernia which accounts for less

More information

INFORMED CONSENT BREAST RECONSTRUCTION WITH DIEP FLAP

INFORMED CONSENT BREAST RECONSTRUCTION WITH DIEP FLAP Purchasers of the Patient Consultation Resource Book are given a limited license to modify documents contained herein and reproduce the modified version for use in the Purchaser's own practice only. All

More information

SURGICAL PREAMBLE SPECIFIC ELEMENTS SURGICAL SERVICES WHICH ARE NOT LISTED AS A "Z" CODE

SURGICAL PREAMBLE SPECIFIC ELEMENTS SURGICAL SERVICES WHICH ARE NOT LISTED AS A Z CODE Surgical PreambleApril 1, 2015 PREAMBLE SPECIFIC ELEMENTS In addition to the common elements, all surgical services include the following specific elements. A. Supervising the preparation of and/or preparing

More information

NORCOM COMMISSIONING POLICY. Specialist Plastic Surgery Procedures

NORCOM COMMISSIONING POLICY. Specialist Plastic Surgery Procedures NORCOM North Derbyshire, South Yorkshire and Bassetlaw Commissioning Consortium NORCOM COMMISSIONING POLICY Specialist Plastic Surgery Procedures January 2007 Review Date: January 2009 Prepared by Rotherham

More information

Anatomic Percutaneous Ankle Reconstruction of Lateral Ligaments (A Percutaneous Anti ROLL)

Anatomic Percutaneous Ankle Reconstruction of Lateral Ligaments (A Percutaneous Anti ROLL) Anatomic Percutaneous Ankle Reconstruction of Lateral Ligaments (A Percutaneous Anti ROLL) Mark Glazebrook James Stone Masato Takao Stephane Guillo Introduction Ankle stabilization is required when a patient

More information

International Guidelines for Specialty Training and Education in Oral and Maxillofacial Surgery

International Guidelines for Specialty Training and Education in Oral and Maxillofacial Surgery International Guidelines for Specialty Training and Education in Oral and Maxillofacial Surgery International Guidelines for Specialty Training and Education in Oral and Maxillofacial Surgery International

More information

Titanium Wire with Barb and Needle. For canthal tendon procedures.

Titanium Wire with Barb and Needle. For canthal tendon procedures. Titanium Wire with Barb and Needle. For canthal tendon procedures. Technique Guide Instruments and implants approved by the AO Foundation Table of Contents Introduction Titanium Wire with Barb and Needle

More information

ANTERIOR CERVICAL DISCECTOMY AND FUSION. Basic Anatomical Landmarks: Anterior Cervical Spine

ANTERIOR CERVICAL DISCECTOMY AND FUSION. Basic Anatomical Landmarks: Anterior Cervical Spine Anterior In the human anatomy, referring to the front surface of the body or position of one structure relative to another Cervical Relating to the neck, in the spine relating to the first seven vertebrae

More information

Cracking CPT Codes: An Interactive Discussion Presented by Tom Loughrey, CCS-P. Jumping Right In!

Cracking CPT Codes: An Interactive Discussion Presented by Tom Loughrey, CCS-P. Jumping Right In! Cracking CPT Codes: An Interactive Discussion Presented by Tom Loughrey, CCS-P Jumping Right In! Code the following: 38 year old female for right breast biopsy with percutaneous needle core using image

More information

How To Improve Your Looks with Plastic Surgery

How To Improve Your Looks with Plastic Surgery How To Improve Your Looks with Plastic Surgery By Daniel Becker Plastic surgery is a special type of surgery that involves both a person's appearance and his or her ability to function. Plastic surgeons

More information

What is the Extended Medicare Safety Net (EMSN) and how does EMSN capping work?

What is the Extended Medicare Safety Net (EMSN) and how does EMSN capping work? What is the Extended Medicare Safety Net (EMSN) and how does EMSN capping work? The Extended Medicare Safety Net (EMSN) provides an additional rebate for Australian families and singles who incur out-of-pocket

More information

GENERAL OTOLARYNGOLOGY HEAD and NECK SURGICAL ONCOLOGY. MEE General ORL/Head and Neck Rotation - PGY 2,3,4,5 Longwood Rotation - PGY 2,3,4,5

GENERAL OTOLARYNGOLOGY HEAD and NECK SURGICAL ONCOLOGY. MEE General ORL/Head and Neck Rotation - PGY 2,3,4,5 Longwood Rotation - PGY 2,3,4,5 GENERAL OTOLARYNGOLOGY HEAD and NECK SURGICAL ONCOLOGY 1. BRIEF DESCRIPTION Training in general otolaryngology, upper aerodigestive tract endoscopy and head and neck oncologic surgery begins and continues

More information

Fourth Nerve Palsy (a.k.a. Superior Oblique Palsy)

Fourth Nerve Palsy (a.k.a. Superior Oblique Palsy) Hypertropia Hypertropia is a type of strabismus characterized by vertical misalignment of the eyes. Among the many causes of vertical strabismus, one of the most common is a fourth nerve palsy (also known

More information

Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery

Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery Medical Necessity Guidelines: Reconstructive and Cosmetic Surgery Effective: October 1, 2015 Clinical Documentation and Prior Authorization Required Coverage Guideline, No Prior Authorization Applies to:

More information

Breast Reconstruction After Mastectomy

Breast Reconstruction After Mastectomy Breast Reconstruction After Mastectomy Breast reconstruction is a type of surgery for women who have had all or part of a breast removed. The surgery rebuilds the breast mound to match the size and shape

More information

UNMH Oral and Maxillofacial Surgery Clinical Privileges

UNMH Oral and Maxillofacial Surgery Clinical Privileges All new applicants must meet the following requirements as approved by the UNMH Board of Trustees effective: 09/26/2014 INSTRUCTIONS Applicant: Check off the "Requested" box for each privilege requested.

More information

Medical Necessity Guidelines: Transgender Surgical Procedures

Medical Necessity Guidelines: Transgender Surgical Procedures Medical Necessity Guidelines: Transgender Surgical Procedures Effective: July 20, 2016 Clinical Documentation and Prior Authorization Required Applies to: Coverage Guideline, No Prior Authorization Tufts

More information

Assuring Data Quality

Assuring Data Quality Assuring Data Quality Jennie Wilson Programme Leader SSI Surveillance Dept. of Healthcare-Associated Infection & Antimicrobial Resistance, Health Protection Agency SSI cumulative incidence (%) 8.0% 7.0%

More information

Neck Dissection Post-Operative Instructions

Neck Dissection Post-Operative Instructions Neck Dissection Post-Operative Instructions What is a neck dissection? A neck dissection is an operation to remove lymph nodes from the neck on one or both sides. What are lymph nodes? Lymph nodes are

More information