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Microsurgery: Free Tissue Transfer and Replantation
MICROSURGERY: FREE TISSUE TRANSFER AND REPLANTATION John R Griffin MD and James F Thornton MD HISTORY In 1964 Nakayama and associates15 reported In the late 1890s and early 1900s surgeons began what is most likely the first clinical series of free- approximating blood vessels, both in laboratory ani- tissue microsurgical transfers. The authors brought mals and human patients, without the aid of magni- vascularized intestinal segments to the neck for cer- fication.1,2 In 1902 Alexis Carrel3 described the vical esophageal reconstruction in 21 patients. The technique of triangulation for blood vessel anasto- intestinal segments were attached by direct microvas- mosis and advocated end-to-side anastomosis for cular anastomoses in vessels 3–4mm diam. Sixteen blood vessels of disparate size. Nylen4 first used a patients had a functional esophagus on follow-up of monocular operating microscope for human ear- at least 1y. drum surgery in 1921. Soon after, his chief, Two separate articles in the mid-1960s described Holmgren, used a stereoscopic microscope for the successful experimental replantation of rabbit otolaryngologic procedures.5 ears and rhesus monkey digits.16,17 Komatsu and 18 In 1960 Jacobson and coworkers,6 working with Tamai used a surgical microscope to do the first laboratory animals, reported microsurgical anasto- successful replantation of a completely amputated moses with 100% patency in carotid arteries as digit in 1968. That same year Krizek and associ- 19 small as 1.4mm diameter. In 1965 Jacobson7 was ates reported the first successful series of experi- able to suture vessels 1mm diam with 100% patency mental free-flap transfers in a dog model. -
UNMH Orthopedic Surgery Clinical Privileges
UNMH Orthopedic Surgery Clinical Privileges Name: Effective Dates: To: o Initial privileges (initial appointment) o Renewal of privileges (reappointment) o Expansion of privileges (modification) All new applicants must meet the following requirements as approved by the UNMH Board of Trustees effective: 05/30/2014 INSTRUCTIONS Applicant: Check off the "Requested" box for each privilege requested. Applicants have the burden of producing information deemed adequate by the Hospital for a proper evaluation of current competence, current clinical activity, and other qualifications and for resolving any doubts related to qualifications for requested privileges. Department Chair: Check the appropriate box for recommendation on the last page of this form. If recommended with conditions or not recommended, provide condition or explanation on the last page of this form. OTHER REQUIREMENTS 1. Note that privileges granted may only be exercised at UNM Hospitals and clinics that have the appropriate equipment, license, beds, staff, and other support required to provide the services defined in this document. Site-specific services may be defined in hospital or department policy. 2. This document defines qualifications to exercise clinical privileges. The applicant must also adhere to any additional organizational, regulatory, or accreditation requirements that the organization is obligated to meet. Qualifications for Orthopedic Surgery Practice Area Code: 42 Version Code: 05-2014a Initial Applicant - To be eligible to apply for privileges in orthopedic -
06-1733 ) Issued: October 17, 2006 DEPARTMENT of the NAVY, MARINE ) CORPS, Camp Lejeune, NC, Employer ) ______)
United States Department of Labor Employees’ Compensation Appeals Board __________________________________________ ) L.S., Appellant ) ) and ) Docket No. 06-1733 ) Issued: October 17, 2006 DEPARTMENT OF THE NAVY, MARINE ) CORPS, Camp LeJeune, NC, Employer ) __________________________________________ ) Appearances: Case Submitted on the Record Appellant, pro se Office of Solicitor, for the Director DECISION AND ORDER Before: ALEC J. KOROMILAS, Chief Judge MICHAEL E. GROOM, Alternate Judge JAMES A. HAYNES, Alternate Judge JURISDICTION On July 24, 2006 appellant filed a timely appeal from the Office of Workers’ Compensation Programs’ June 9, 2006 merit decision terminating her compensation. Pursuant to 20 C.F.R. §§ 501.2(c) and 501.3(d)(2), the Board has jurisdiction over the merits of this case. ISSUE The issue is whether the Office met its burden of proof to terminate appellant’s compensation effective June 10, 2006 on the grounds that she no longer had residuals of her employment injury after that date. FACTUAL HISTORY On May 5, 2000 appellant, then a 52-year-old registered dental hygienist, filed an occupational disease claim alleging that she sustained a ganglion cyst on the dorsum of her right wrist due to repeatedly grasping instruments at work. The Office accepted that appellant sustained a ganglion cyst of her right wrist. She stopped work on May 5, 2000 to undergo an excision of the mass of her ganglion cyst and repair of the extensor tendon of the right long finger. The surgery was performed by Dr. Richard S. Bahner, an attending Board-certified orthopedic surgeon, and was authorized by the Office. In July 2000, appellant returned to light-duty work on a full-time basis for the employing establishment. -
POST-OPERATIVE INSTRUCTIONS for HAND / UPPER EXTREMITY SURGERY Department of Orthopaedics ------After Your Surgery, Follow the Instructions As Checked Below
POST-OPERATIVE INSTRUCTIONS FOR HAND / UPPER EXTREMITY SURGERY Department of Orthopaedics --------------------------------------------------------------------------------------------------------------------------------------------------------------- After your surgery, follow the instructions as checked below. Instructions following anesthesia or sedation The medicines and/or anesthesia that you received today are strong and will affect your body for at least the next few hours. You may have trouble with coordination or thinking because of these medicines. For your safety, follow these instructions carefully for the next 24 hours: Do not drive at all. You must be taken home today by a responsible adult. Do not drink any alcoholic beverages You should rest today. Do not go to work. You should not do things that require you to think and act quickly. You should not do things that require careful work. For example, avoid cooking, sewing, and operating machinery or electrical appliances. You should not make important decisions or sign legal papers today. The medicines may make you feel drowsy or sick to your stomach. Or you may have a poor appetite. If these problems last longer than 24 hour or if they are severe, call your doctor. Medicines Refer to separate “Patient Medication List” Pain and Prescription Medicine You have been given a prescription for pain medicine. Take it as directed. Do not drive or drink alcohol while you are taking “narcotic” pain medicines. This includes medicine like: Percocet® (oxycodone hydrochloride; acetaminophen), Tylenol #3® (acetaminophen; codeine) and Vicodin® (hydrocodone bitartrate; acetaminophen). Nausea, dizziness and drowsiness are normal side effects of prescribed pain medicine. If you have these symptoms and can not tolerate them, stop taking the medicine. -
Basic Standards for Fellowship Training in Orthopedic Hand Surgery BOT 7/2011, Effective 7/2012 Page 2
Basic Standards for Fellowship Training in Orthopedic Hand Surgery American Osteopathic Association and American Osteopathic Academy of Orthopedics TABLE OF CONTENTS Article I: Introduction .................................................................................................. 3 Article II: Mission ........................................................................................................... 3 Article III Educational Program Goals/Core Competencies .................................... 3 Article IV: Institutional Requirements .......................................................................... 3 Article V: Program Requirements and Content .......................................................... 4 Article VI: Program Director / Faculty Qualifications ............................................... 5 Article VII: Fellow Requirements ..................................................................................... 5 Article VIII: Evaluation ....................................................................................................... 5 Basic Standards for Fellowship Training in Orthopedic Hand Surgery BOT 7/2011, Effective 7/2012 Page 2 Basic Standards for Fellowship Training in Orthopedic Hand Surgery This is an amendment to the Basic Standards for Residency Training in Orthopedic Surgery which governs and defines orthopedic surgical training. The Basic Standards are, therefore, incorporated into this document. SECTION I - INTRODUCTION These are the Basic Standards for Fellowship Training in Orthopedic -
Hand Surgery: a Guide for Medical Students
Hand Surgery: A Guide for Medical Students Trevor Carroll and Margaret Jain MD Table of Contents Trigger Finger 3 Carpal Tunnel Syndrome 13 Basal Joint Arthritis 23 Ganglion Cyst 36 Scaphoid Fracture 43 Cubital Tunnel Syndrome 54 Low Ulnar Nerve Injury 64 Trigger Finger (stenosing tenosynovitis) • Anatomy and Mechanism of Injury • Risk Factors • Symptoms • Physical Exam • Classification • Treatments Trigger Finger: Anatomy and MOI (Thompson and Netter, p191) • The flexor tendons run within the synovial tendinous sheath in the finger • During flexion, the tendons contract, running underneath the pulley system • Overtime, the flexor tendons and/or the A1 pulley can get inflamed during finger flexion. • Occassionally, the flexor tendons and/or the A1 pulley abnormally thicken. This decreases the normal space between these structures necessary for the tendon to smoothly glide • In more severe cases, patients can have their fingers momentarily or permanently locked in flexion usually at the PIP joint (Trigger Finger‐OrthoInfo ) Trigger Finger: Risk Factors • Age: 40‐60 • Female > Male • Repetitive tasks may be related – Computers, machinery • Gout • Rheumatoid arthritis • Diabetes (poor prognostic sign) • Carpal tunnel syndrome (often concurrently) Trigger Finger: Subjective • C/O focal distal palm pain • Pain can radiate proximally in the palm and distally in finger • C/O finger locking, clicking, sticking—often worse during sleep or in the early morning • Sometimes “snapping” during flexion • Can improve throughout the day Trigger Finger: -
Code Procedure Cpt Price University Physicians Group
UNIVERSITY PHYSICIANS GROUP (UPG) PRICES OF PROVIDER SERVICES CODE PROCEDURE MOD CPT PRICE 0001A IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 1ST DOSE 0001A $40.00 0002A IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 2ND DOSE 0002A $40.00 0011A IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE 0011A $40.00 0012A IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE 0012A $40.00 0021A IMM ADMN SARSCOV2 5X1010 VP/0.5 ML 1ST DOSE 0021A $40.00 0022A IMM ADMN SARSCOV2 5X1010 VP/0.5 ML 2ND DOSE 0022A $40.00 0031A IMM ADMN SARSCOV2 AD26 5X10^10 VP/0.5 ML 1 DOSE 0031A $40.00 0042T CEREBRAL PERFUS ANALYSIS, CT W/CONTRAST 0042T $954.00 0054T BONE SURGERY USING COMPUTER ASSIST, FLURO GUIDED 0054T $640.00 0055T BONE SURGERY USING COMPUTER ASSIST, CT/ MRI GUIDED 0055T $1,188.00 0071T U/S LEIOMYOMATA ABLATE <200 CC 0071T $2,500.00 0075T 0075T PR TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL 26 26 $2,208.00 0126T CAROTID INT-MEDIA THICKNESS EVAL FOR ATHERSCLER 0126T $55.00 0159T 0159T COMPUTER AIDED BREAST MRI 26 26 $314.00 PR RECTAL TUMOR EXCISION, TRANSANAL ENDOSCOPIC 0184T MICROSURGICAL, FULL THICK 0184T $2,315.00 0191T PR ANT SEGMENT INSERTION DRAINAGE W/O RESERVOIR INT 0191T $2,396.00 01967 ANESTH, NEURAXIAL LABOR, PLAN VAG DEL 01967 $2,500.00 01996 PR DAILY MGMT,EPIDUR/SUBARACH CONT DRUG ADM 01996 $285.00 PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> 0200T NDL 0200T $5,106.00 PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> 0201T NDLS 0201T $9,446.00 PR INJECT PLATELET RICH PLASMA W/IMG 0232T HARVEST/PREPARATOIN 0232T $1,509.00 0234T PR TRANSLUMINAL PERIPHERAL ATHERECTOMY, RENAL -
Psi Technical Specs V31.Pdf
AHRQ Quality Indicators Patient Safety Indicators: Technical Specifications Department of Health and Human Services Agency for Healthcare Research and Quality http://www.qualityindicators.ahrq.gov March 2003 Version 3.1 (March 12, 2007) AHRQ Quality Indicators Web Site: http://www.qualityindicators.ahrq.gov Table of Contents About the Patient Safety Indicators ............................................................................................................... 1 Patient Safety Indicators – Detailed Definitions ............................................................................................ 3 Complications of Anesthesia (PSI 1) ............................................................................................................ 3 Death in Low-Mortality DRGs (PSI 2) ........................................................................................................... 5 Decubitus Ulcer (PSI 3) ................................................................................................................................. 7 Failure to Rescue (PSI 4) .............................................................................................................................. 9 Foreign Body Left during Procedure, Secondary Diagnosis Field (PSI 5 and 21)...................................... 17 Iatrogenic Pneumothorax, Secondary Diagnosis Field (PSI 6 and 22)....................................................... 18 Selected Infections Due to Medical Care, Secondary Diagnosis Field (PSI 7 and 23) ............................. -
Plastic Surgery Essentials for Students Handbook to All Third Year Medical Students Concerned with the Effect of the Outcome on the Entire Patient
AMERICAN SOCIETY OF PLASTIC SURGEONS YOUNG PLASTIC SURGEONS STEERING COMMITTEE Lynn Jeffers, MD, Chair C. Bob Basu, MD, Vice Chair Eighth Edition 2012 Essentials for Students Workgroup Lynn Jeffers, MD Adam Ravin, MD Sami Khan, MD Chad Tattini, MD Patrick Garvey, MD Hatem Abou-Sayed, MD Raman Mahabir, MD Alexander Spiess, MD Howard Wang, MD Robert Whitfield, MD Andrew Chen, MD Anureet Bajaj, MD Chris Zochowski, MD UNDERGRADUATE EDUCATION COMMITTEE OF THE PLASTIC SURGERY EDUCATIONAL FOUNDATION First Edition 1979 Ruedi P. Gingrass, MD, Chairman Martin C. Robson, MD Lewis W.Thompson, MD John E.Woods, MD Elvin G. Zook, MD Copyright © 2012 by the American Society of Plastic Surgeons 444 East Algonquin Road Arlington Heights, IL 60005 All rights reserved. Printed in the United States of America ISBN 978-0-9859672-0-8 i INTRODUCTION PREFACE This book has been written primarily for medical students, with constant attention to the thought, A CAREER IN PLASTIC SURGERY “Is this something a student should know when he or she finishes medical school?” It is not designed to be a comprehensive text, but rather an outline that can be read in the limited time Originally derived from the Greek “plastikos” meaning to mold and reshape, plastic surgery is a available in a burgeoning curriculum. It is designed to be read from beginning to end. Plastic specialty which adapts surgical principles and thought processes to the unique needs of each surgery had its beginning thousands of years ago, when clever surgeons in India reconstructed individual patient by remolding, reshaping and manipulating bone, cartilage and all soft tissues. -
Lengthening by Distraction Osteogenesis in Congenital Shortening of Metacarpals
ORIGINAL ARTICLE Acta Orthop Traumatol Turc 2013;47(2):79-85 doi:10.3944/AOTT.2013.3080 Lengthening by distraction osteogenesis in congenital shortening of metacarpals Mehmet BULUT1, Bekir Yavuz UÇAR1, ‹brahim AZBOY1, Oktay BELHAN2, Erhan YILMAZ2, Lokman KARAKURT2 1Department of Orthopedics and Traumatology, Faculty of Medicine, Dicle University, Diyarbak›r, Turkey; 2Department of Orthopedics and Traumatology, Faculty of Medicine, F›rat University, Elaz›¤, Turkey Objective: The aim of this study was to present the results of seven cases of metacarpal lengthening by distraction osteogenesis and to discuss the ideal daily rate of distraction. Methods: Metacarpal lengthening was performed by distraction osteogenesis in the seven metacarpals of four patients (3 females, 1 male; mean age: 14.9 years). A unilateral external fixator was used for length- ening. Lengthening was initiated with a distraction rate of 2×0.5 mm/day in the patient with bilateral involvement of the middle and ring metacarpals. On the tenth day of lengthening, distraction was discon- tinued due to pain and contracture. Then, distraction was continued with a rate of 2×0.25 mm/day. In all other cases, the distraction rate was 0.5 mm/day. Pre- and postoperative range of motion was measured with a goniometer. Patient satisfaction was evaluated with visual analog scale. Results: The mean pre- and postoperative metacarpal lengths were 34.6 mm (range: 33 to 37) and 49.7 mm (range: 47 to 52), respectively. The mean lengthening achieved was 15.1 mm (range: 14 to 17), while the mean distraction rate was 0.55 mm/day (range: 0.48 to 0.63). -
Lasers in Spine Surgery: a Review
current concepts invited review Lasers in Spine Surgery: A Review Jack Stern, MD, PhD, FACS Introduction White Plains, NY A Google search with the key words “spine surgery” results in a list of individuals and “in- stitutes” emphasizing the use of laser technology. The words “laser” and “spine surgery” top the list of paid sponsors. A review of print media content in New York also reveals this strong association. Printed ads extolling the virtues of superior surgical outcomes with laser surgery have run for many years. The combination of these two words clearly prompts patient interest. The substantial long-term costs of print ads would indicate that they also prompt patient response. The general notion is that laser surgery results in less blood loss, is less invasive and is more ef- fective in treating a variety of spinal conditions, especially herniated discs. This author polled 24 neurosurgeons and orthopedic spine surgeons in the New York City area. Interestingly, while two thirds use minimally invasive techniques, none use laser technology. In the hope of providing some clarity, this review is intended to address: 1. The basic physics of lasers. 2. The general applicability of lasers in surgical practice. 3. The role of lasers in spinal surgery. 4. Review of pertinent literature with emphasis on outcomes. Basic Physics of Lasers Laser is an acronym for light amplification by stimulated emission of radiation. In this case, “light” refers to the ultraviolet (UV) (150 to 400 nm), visible (390 to 700 nm) and infrared (greater than 700 nm) portions of the electromagnetic spectrum produced by “stimulated emission,” a process that imparts the monochromaticity and coherence of laser light. -
Icd-9-Cm (2010)
ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular