NON-HOSPITAL MEDICAL AND SURGICAL FACILITIES ACCREDITATION PROGRAM College of Physicians and Surgeons of British Columbia 300–669 Howe Street Telephone: 604-733-7758 Vancouver BC V6C 0B4 Toll Free: 1-800-461-3008 (in BC) www.cpsbc.ca Fax: 604-733-3503 Appropriate Procedures List PLASTIC SURGERY Physician name: CPSID: Facility applying to: Please indicate only the procedures you wish to perform at the above-mentioned facility. Skin grafts – split thickness or full thickness Abdomen Face Abdominal panniculectomy Biopsy Abdominoplasty Blephroplasty – upper and/or lower Biopsy Browlift Drainage/aspiration Chin augmentation Excision – tumour, cyst, soft tissue mass Cleft lip – bilateral complete Irrigation and debridement Debridement – joint Lipectomy Drainage/aspiration Scar revision Excision – scar Suction lipectomy* Excision – tumour, cyst, soft tissue mass Upper extremities Facelift Biopsy Irrigation and debridement Brachioplasty Malar augmentation Drainage/aspiration Mandibular osteotomy – internal fixation – bilateral Excision – tumour, cyst, soft tissue mass Maxillary fracture zygomatic – arch – open reduction Irrigation and debridement and wiring Suction lipectomy* Maxillary fracture zygomatic – reduction Tenolysis Nasal fracture – wire plate fixation – open reduction Breast Neck lift Breast augmentation Orbital floor open reduction Capsulectomy/capsulotomy Osteotomies, mandibular maxillofacial – bilateral Drainage/aspiration Otoplasty Excision – tumour, cyst, soft tissue mass Ptosis repair Excision gynecomastia Removal forehead wrinkles Insertion tissue expanders Repair lacerations Irrigation and debridement Rhinoplasty Mastopexy Scalp lift Nipple areolar reconstruction and/or tattooing Scar revision Reduction mammoplasty Suction lipectomy* Scar revision Suction lipectomy* 1 of 2 Appropriate Procedures List – Plastic Surgery College of Physicians and Surgeons of British Columbia Please indicate only the procedures you wish to perform at the above-mentioned facility. Median nerve release (endoscopic or open) Gender affirmation surgery Chest construction — removal of breast tissue with or Needle aponeurotomy – hand deformity without contouring Nerve block Breast construction — breast augmentation Nerve repair Neurolysis Groin, buttock and lower extremities ORIF – carpal bone, scaphoid, carpus, phalangeal Biopsy fracture Buttock lift Osteotomy Drainage/aspiration Palmar fasciectomy Excision – tumour, cyst, soft tissue mass Removal loose body Hymenoplasty Scapholunate reconstruction Irrigation and debridement Tendon release Labiaplasty Tendon repair Laser vaginal resurfacing Tendon transfer Scar revision Tenolysis Suction lipectomy* Tenoplasty Thigh lift Tenosynovectomy Hand and wrist Triangular fibrocartilage complex (TFDD) repair Amputation – finger(s), transmetacarpal Skin Arthrodesis Biopsy Arthroplasty – finger joint Dermabrasion Arthroscopy Drainage/aspiration Arthrotomy – MP/PIP/DIP joints Excision – tumour, cyst, soft tissue mass Biopsy Irrigation and debridement Bone grafting – metacarpal/phalanx Scar revision Closed reduction Debridement – joint Tendon Excision – tumour, cyst, soft tissue mass Open tendon lengthening External fixation Repair and reconstruction Ganglia excision Soft tissue release – muscle or tendon Hand and wrist – internal fixation device – removal Tendon repair Implant arthroplasty – metatarsal phalangeal joint Tendon transfer/transplant Irrigation and debridement Ligament reconstruction Manipulation *Total aspirate should not exceed 5000 ml. I hereby certify that the procedures selected in this application are within the scope of my current practice. Physician signature: Date: Physician name: CPSID: Facility applying to: 2 of 2.