1. Plastic Surgery SCGH Unit Audit 20 th of September – 5 th of December 2004 Marosh Vrtik Lip Teh David Oliver

2. OVERVIEW  Outpatient Clinics  Plastics Dressings Clinic  Inpatient Information  Operative Data  Complications  Presentation  Discussion

3. Outpatient Clinic Case Load Follow up NewTotal Year To Date P. Briggs 16651217924 C. Allen 9433127516 T. Cooper 12246168682 S. Hamilton 15741198775 R. Page ---145 J. Savundra 1952046 TOTAL5581767303088

4. Outpatient Clinic Case Load 2002: 3167 2002: 3167 2003: 3195 2003: 3195 2004: 3289 2004: 3289

5. Plastics Dressings Clinic Audit Period New Cases 303 Follow up 1638 Total:1941

6. Plastics Dressings Clinic 2002 2002 2003 2003 2004 2004 New Cases 100110711332 Follow up 673267297478 Total:773378008810

7. Admissions Audit Period ALOS ALOS Allen C. 712.99 Briggs P. 1182.17 Hanikeri M. 23.5 Cooper T. 1001.99 Hamilton S. 433.88 Love R. 53.00 Savundra J. 761.87 TOTAL3312.02

8. Admissions 2002 2002 2003 2003 2004 2004incomplete Unit Total: 185118411912 Unit ALOS: 3.322.632.79

9. Operations by Providers Audit Period Allen C. 60 Allen C. 60 Briggs P. 100 Briggs P. 100 Cooper T. 91 Cooper T. 91 Hamilton S. 40 Hamilton S. 40 Hanikeri M. 5 Hanikeri M. 5 Love R. 6 Love R. 6 Savundra J. 45 Savundra J. 45 TOTAL: 347 TOTAL: 347

10. Operations 2002 2002 2003 2003 2004 2004Incomplete Total 1693 1693 1722 1722 1829 1829

11. Operations by Categories General Plastics 159 General Plastics 159 Hand Surgery 152 Hand Surgery 152 Breast Surgery 19 Breast Surgery 19 Craniofacial 16 Craniofacial 16 Microsurgery 7 Microsurgery 7 Head and Neck 7 Head and Neck 7 Cosmetic Surgery 4 Cosmetic Surgery 4 Burns 0 Burns 0 TOTAL: 363 TOTAL: 363

12. FLAPS FREE : TRAM 3 FREE : TRAM 3 Radial forearm 1 Radial forearm 1 Rectus myocutaneous 2 Rectus myocutaneous 2 Thumb replant 1 Thumb replant 1 Pedicled: Lat Dorsi 4 Pedicled: Lat Dorsi 4 Gastrocnemius 1 Gastrocnemius 1 Reverse Radial Forearm 1 Reverse Radial Forearm 1 TRAM 2 TRAM 2

13. Operative Experience Lip TEH Assistance Assistance 1 st Operator 1 st Operator Microsurgery04 Hand Surgery 392 General Plastics 462 Breast Surgery 310 Head and Neck 11 Cosmetics20 Craniofacial59 Total:187

14. Operative Experience Marosh Vrtik Assistance Assistance 1 st Operator 1 st Operator Hand Surgery 1548 General plastics 747 Breast Surgery 40 Head and neck 40 Craniofacial12 Cosmetic20 Micro02 Total: 125

15. Operative Experience David Oliver Assistance Assistance 1 st Operator 1 st Operator Hand Surgery 1052 General plastics 835 Breast Surgery 74 Head and neck 10 Craniofacial34 Cosmetic10 Micro03 Total: 128

16. Use of Elective Lists for Trauma During Audit Period  41 registrar lists (11 weeks)  3 cases per list -> 123 slots available  225 trauma cases  60 trauma cases on elective lists i.e. “cancellations”

17. Time from Presentation to SURGERY 18 Patients 18 Patients Range: 1.75 – 48 hours Range: 1.75 – 48 hours Average: 13.8 hours Average: 13.8 hours < 6 hours 7 patients < 6 hours 7 patients > 6 hours 2 patients > 6 hours 2 patients >12 hours 3 patients >12 hours 3 patients >18 hours 2 patient >18 hours 2 patient >24 hours 3 patients >24 hours 3 patients 48 hours 1 patient 48 hours 1 patient

18. Complications: Incomplete excisions 110 Patients with cutaneous lesions 110 Patients with cutaneous lesions 7 (6%) incomplete excisions for skin lesions Clive Foley (SCC-insitu cheek) – Hamilton Clive Foley (SCC-insitu cheek) – Hamilton Dawn Brennan (BCC nose) – Allen Dawn Brennan (BCC nose) – Allen Marion Rawlings (BCC ear) – Cooper Marion Rawlings (BCC ear) – Cooper Ronald Fernihough (SCC parotid) - Allen Ronald Fernihough (SCC parotid) - Allen Richard Roberts (BCC scalp) – Cooper Richard Roberts (BCC scalp) – Cooper Trevor Graham (melanoma chest) - Hamilton Trevor Graham (melanoma chest) - Hamilton Hector Mason (BCC ear) - Cooper Hector Mason (BCC ear) - Cooper

19. Complications: Level 3 Eric Kay Mr. Allen Eric Kay Mr. Allen 72 year old man 72 year old man Adenoid cystic carcinoma Rt Maxilla Adenoid cystic carcinoma Rt Maxilla Maxillectomy and reconstruction with free rectus flap and rib grafts 5.11.04 Maxillectomy and reconstruction with free rectus flap and rib grafts 5.11.04 Reexplored 7.11.04 ?venous congestion Reexplored 7.11.04 ?venous congestion Opthalmoplegia, pulmonary oedema, left sided pneumonia, staph sepsis Opthalmoplegia, pulmonary oedema, left sided pneumonia, staph sepsis

20. Complications: Level 3 Rebecca FERNANDEZ Mr. Allen Rebecca FERNANDEZ Mr. Allen 20 year old female 20 year old female T4 N1 M0 SCC tongue T4 N1 M0 SCC tongue Glossectomy, bilateral neck dissection and reconstruction with free rectus flap 22.10.04 Glossectomy, bilateral neck dissection and reconstruction with free rectus flap 22.10.04 Reexplored 23.10.04 ?arterial occlussion Reexplored 23.10.04 ?arterial occlussion Tongue flap debulked 3 weeks later Tongue flap debulked 3 weeks later

21. Complications: Level 3 Earl BOXALL Mr. Cooper Earl BOXALL Mr. Cooper 54 year old male 54 year old male T3 N1 SCC floor of mouth T3 N1 SCC floor of mouth WLE, marginal mandibulectomy, bilateral neck dissection and reconstruction with free radal forearm flap 22.11.04 WLE, marginal mandibulectomy, bilateral neck dissection and reconstruction with free radal forearm flap 22.11.04 Reexplored 23.11.04 venous occlussion Reexplored 23.11.04 venous occlussion 1 vein thrombosed, 1 vein kinked 1 vein thrombosed, 1 vein kinked Incomplete excision – reexcision planned 20.12.04 Incomplete excision – reexcision planned 20.12.04

22. Complications: Level 3 Diane KIRBY Mr. Allen Diane KIRBY Mr. Allen 55 year old woman 55 year old woman LT Lar Dorsi and Expander Breast Recon 24.9.04 LT Lar Dorsi and Expander Breast Recon 24.9.04 Cellulitis and ?Ruptured expander 11.12.04 Cellulitis and ?Ruptured expander 11.12.04 Removal of expander 15.12.04 Removal of expander 15.12.04 Micro coag neg staph Micro coag neg staph

23. Complications Level 3 Laura GRIMESMr. Allen Laura GRIMESMr. Allen 50 yr old female 50 yr old female Lt Lat dorsi and expander reconstruction Jan 04 Lt Lat dorsi and expander reconstruction Jan 04 Admitted for cellulitis 5.11.04 Admitted for cellulitis 5.11.04 Unresponsive to IV antibiotics Unresponsive to IV antibiotics Washout and implant removal 10.11.04 Washout and implant removal 10.11.04 Micro no growth Micro no growth

24. Complications: Level 3 Olive CARBONIMr. Allen Olive CARBONIMr. Allen 69 year old female 69 year old female Lt calf degloving laceration Lt calf degloving laceration Suture repair 2.10.04 Suture repair 2.10.04 Flap necrosis and cellulitis Flap necrosis and cellulitis Debridement and SSG 11.10.04 Debridement and SSG 11.10.04

25. Complications: Level 3 Craig DIXON Mr. Cooper Craig DIXON Mr. Cooper 28 year old man 28 year old man Post traumatic scar contracture left third ray Post traumatic scar contracture left third ray Scar release, Z plasties 12.10.04 Scar release, Z plasties 12.10.04 Skin necrosis, exposed flexor tendons Skin necrosis, exposed flexor tendons Cross finger flap 21.10.04 Cross finger flap 21.10.04

26. Complications Level 3 Timothy GROUNDSMr. Savundra/Love Timothy GROUNDSMr. Savundra/Love - 40 yr old man - 40 yr old man - Bilateral buttock pressure ulcers - Bilateral buttock pressure ulcers - Debrided 29.10.04 - Debrided 29.10.04 - Direct closure Lt side 2.12.04 - Direct closure Lt side 2.12.04 dehisced following seizure - SSG 13.12.04 - SSG 13.12.04

27. Complications Level 3 Cheryl BUCHANENMr. Briggs Cheryl BUCHANENMr. Briggs 50yr old female 50yr old female Bilateral wrist lacerations Bilateral wrist lacerations Repaired 10.11.04 Repaired 10.11.04 Infected with enterobacter cloacae Infected with enterobacter cloacae Washout 15.11.04 – ruptured FCR Washout 15.11.04 – ruptured FCR

28. Complications Level 3 Anne HULLMr. Savundra Anne HULLMr. Savundra 52yr old female 52yr old female Rt leg laceration from lawn mover Rt leg laceration from lawn mover Repaired 19.11.04 Repaired 19.11.04 Skin necrosis/cellulitis Skin necrosis/cellulitis Debrided 26.11.04 Debrided 26.11.04 SSG 31.11.04 SSG 31.11.04

29. Complications Level 3 Richard ROBERTSMr. Cooper Richard ROBERTSMr. Cooper 70 yr old male 70 yr old male BCC scalp 26.11.04 BCC scalp 26.11.04 Excision and SSG Excision and SSG Hematoma, loss of SSG, incomplete excision Hematoma, loss of SSG, incomplete excision Reexcision and SSG 3.12.04 Reexcision and SSG 3.12.04

30. Complications Level 3 Andrea SKAHILLMr. Hamilton Andrea SKAHILLMr. Hamilton 41yr old female 41yr old female Munchausens Munchausens Chronic Left thigh ulcer Chronic Left thigh ulcer Debridement and SSG harvest 21.10.04 Debridement and SSG harvest 21.10.04 Complete SSG loss Complete SSG loss Debrided, SSG harvest and tension banding 2.12.04 Debrided, SSG harvest and tension banding 2.12.04

31. Complications Level 3 Kevin THOMPSONMr. Cooper Kevin THOMPSONMr. Cooper 43 yr old male 43 yr old male Bilateral trigger finger releases (RIF,RMF,RRF,LMF,LRF) 5.10.04 Bilateral trigger finger releases (RIF,RMF,RRF,LMF,LRF) 5.10.04 RIF still triggering RIF still triggering Explored LAOP 18.11.04 Explored LAOP 18.11.04 Synovectomy, partial A2 pulley release Synovectomy, partial A2 pulley release