title: Quality improvement of microsurgery through telecommunication--the postoperative care after microvascular transfer of intestine.
abstract: The purpose of this report is to describe the use of telecommunication to improve the quality of postoperative care following microsurgery, especially following microvascular transfer of intestinal transfer for which shortening of ischemia time is of utmost importance to achieve high success rate. From 2003 to 2009 microvascular transfer of intestinal flaps had been performed in 112 patients. After surgery the patients were put in intensive care unit and the flaps were checked every 1 hour. The image for circulatory status of the flaps was sent directly to the attending surgeon for judgment. The information was sent through intranet and the surgeon can get access to the intranet through internet if necessary. Among the 112 cases, there were 9 cases of reexploration. The average duration between the time of problem detection and the time of starting reexploration was 54 min in 7 cases, and other 2 cases were delayed to enter the operating room which had been occupied by other cases of major trauma. Only two flaps were lost completely, two patients developed narrowing at the junction of cervical esophagus and thoracic esophagus. The rate of salvage for intestinal flap is apparently higher than those reported in the literature. In the postoperative management of microsurgery in ICU, telecommunication can help to reduce the ischemia time after vascular compromise in the transfer of free intestinal flap. Telecommunication is really an easy and effective tool in improving the outcome of reconstructive surgery.
authors.affiliation: Plastic Surgery, China Medical Hospital, China Medical University, Taiwan.
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
authors.forename: Hsin-Chih
authors.initials: HC
authors.lastname: Kuo
authors.forename: Kuo-Piao
authors.initials: KP
authors.lastname: Chung
authors.forename: Shih-Heng
authors.initials: SH
authors.lastname: Chen
authors.forename: Yueh-Bih
authors.initials: YB
authors.lastname: Tang
authors.forename: Syi
authors.initials: S
authors.lastname: Su
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006084:Graft Rejection; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000601:surgery; D007422:Intestines / Q000601:surgery / Q000637:transplantation*; D007511:Ischemia / Q000517:prevention & control / Q000628:therapy; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011182:Postoperative Care / Q000379:methods*; D058996:Quality Improvement; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013685:Telecommunications; D013964:Thyroid Neoplasms / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014741:Video Recording