Many surgeons, however, are concerned that corneal protectors distort eyelid anatomy and therefore do not use them during blepharoplasty or face lift. At a minimum, eye lubricant should be used if the eyelids cannot be taped or protected otherwise.
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This simple intervention may help avoid corneal abrasion with suture or, worse, globe trauma. In some positions, such as prone, a significant amount of pressure can be applied to the eyes. If the pressure on the eye is greater than venous pressure, blood outflow is impeded and retinal hemorrhage is possible. If the pressure on the eye is greater than arterial pressure, inflow of oxygenated blood is stopped and retinal ischemia and blindness ensue. There are no data to prove its benefit, but many plastic surgeons currently use goggles Dupaco, Oceanside, CA and prone pillows Orthopedic Systems, Union City, CA to protect the eyes and face from undue pressure in the prone position.
Electrosurgery describes the use of the Bovie or electrocautery. In electrosurgery, an electrode is used to create a circuit and conduct heat into a concentrated area. The electrosurgical generator is the source of electrons and voltage.
In bipolar electrosurgery, the return electrode is the second prong of the pickups, thereby concentrating the current at the area of interest and avoiding current through the patient's body. Over the years, electrosurgery has evolved. At one time, the circuit to the ground was completed by the path of least resistance on the patient. This caused current division and allowed alternate site burns at areas of least resistance even when grounding pads were in place.
Today, however, generators come equipped with isolated generators that complete the circuit within the unit themselves. These isolated generators eliminated alternate site burns but did nothing to protect from return electrode burns at the site of grounding pad placement.
The only difference between the active electrode, or the Bovie tip, and the grounding electrode is size and conductivity. If there is poor contact between the grounding pad and the patient, however, severe burns can develop as the current becomes concentrated on a smaller surface area. Inadvertent movement of the pad or poor placement can cause severe burns in a patient undergoing a simple procedure. To avoid this devastating complication, the grounding pads should be placed in areas without excessive hair, bony prominences, or adhesive failure and should be applied in such a way as to guarantee that the entire gel pad is in contact with the patient.
Burns can also occur as a result of inadvertent placement of an active electrode on the patient's body. This can be avoided with meticulous placement of the tip of the instrument when it is not in use. For example, the tip should never be left on the patient's body because accidental activation will cause a burn injury. By following these simple guidelines and paying attention to the active electrode as well as appropriate placement and monitoring of the grounding pad, unintentional burns can virtually be eliminated.
Abrasion and sore throat after a procedure requiring prolonged endotracheal intubation are common. Although this is certainly not life threatening, it is an annoyance for hours to days postoperatively. There are no studies explaining why some patients suffer with throat pain and others do not. One retrospective review of over cases identified several risk factors associated with postoperative sore throat. These include the female gender, age between 30 and 39, surgery within the oral cavity and around the neck, use of nitrous oxide for anesthesia, and duration of procedure greater than 2 hours.
There is no standard treatment or approach that minimizes the degree of postoperative sore throat. Some use preoperative lidocaine spray or jelly to bathe the endotracheal tube.
If appropriate for the patient and the procedure being performed, the laryngeal mask airway LMA can also be used to avoid sore throat. Safety and patient comfort in the operating room have become increasingly important. Preventable complications are always a concern to the surgeon, and the pressure to avoid complications during elective cosmetic procedures is greater now than ever before. Safe and effective patient positioning can avoid frustrating nerve damage and postoperative muscle and joint pain.
Traditionally, surgeons have left patient positioning to the nursing and anesthesia staff. Because responsibility for postoperative complications due to poor patient positioning ultimately lies with the surgeon, he or she should take an active role and follow basic guidelines in patient positioning. Attention to the head and neck during the procedure is imperative because of the risk of devastating retinal ischemia, brachial plexus injury, and damage to the vertebral vessels.
Although eye injury during nonocular surgery is rare, it should be an avoidable complication. There are no strict guidelines for how to protect the cornea and globe from injury; however, it is commonly accepted that taping the eyes shut when possible helps to prevent injury.
Further, protecting the eyes from excess pressure when in the prone position may help avoid the grave complication of retinal ischemia and blindness. Finally, inadvertent electrical burns in the operating room must be avoided by vigilant attention to equipment placement and correct usage of electrosurgical instruments.
Careful attention to patient safety must remain the number one goal of the surgeon. Consideration of the many patient safety issues allows a smooth perioperative course, thereby improving the treatment tuberculosis guidelines national programmes surgery experience while optimizing patient safety.
National Center for Biotechnology InformationU. Journal List Semin Plast Surg v. Semin Plast Surg. Warren A. Ellsworth, IVM. IversonM.
Ellsworth, IV. Ronald E. Author information Copyright and License information Disclaimer. Address for correspondence and reprint requests: Warren A. Ellsworth IV M. There is no clear definition of medical tourism, however, Neil and colleagues define medical tourists as patients who are mobile through their own volition to seek medical care abroad.
Currently, only a few studies have investigated push and pull factors for medical tourists seeking to travel for treatment. Affordability and greater patient savings were the primary motives to seek medical care abroad. As the majority of surgical tourism occurs in the private sector without formal referral and prior consultation from clinical gatekeepers or public health providers, this gap in the care network has impacted on the management of surgical tourists.
However, there is a paucity of published literature regarding the complications arising from cosmetic surgery performed abroad. A recent review article stratified patient risk profiles against outcomes for cosmetic tourism involving breast augmentation surgery While there have been a limited number of studies on medical tourism in the travel medicine literature 12the focus of these has not been on individuals who travel for the purposes of undergoing cosmetic surgery.
The current review aims to critically address the scale and impact of cosmetic surgical tourism and its specific complication profile. All literature relevant to cosmetic surgery tourism and published through November was examined. The main focus of the review was surgical tourism and complications surrounding procedures.
Articles published in the English language on the PubMed database that focused on surgical tourism and complications of elective surgical procedures abroad were interrogated. The following were excluded from this review: papers that were published in any language other than English, laws and directives, papers focusing on emergency surgical procedures abroad, articles involving paediatric surgical procedures abroad and articles involving non-surgical cosmetic procedures. Reference lists of articles identified were further examined.
The initial yield of papers was reviewed based on the set criteria. Articles that were not accessible in full text were excluded.
Global profile of cosmetic surgical procedure This is due to an increasing ageing population, rise in pharmaceutical costs and demand in medical and surgical interventions which have threatened the availability of continued full service to all patients. Although case by case exceptions are made, this is the main reason cosmetic surgery is primarily undertaken in the private sector. Castonguay and colleagues established that considerably lower initial cost is one of the primary reasons cosmetic tourism has become an increasingly common practice.
Table 1. Relative costs of cosmetic surgical procedures worldwide Miyagi and colleagues undertook a prospective study on a cohort of 19 patients presenting to the NHS plastic surgery department from to due to complications from cosmetic surgery performed abroad. Conservative management was offered to only 44 patients; however, 24 patients from this study required inpatient care and surgery. A response rate of However, this survey failed to stratify data for procedure type and absolute number for rates of complication were not accounted.
A survey of members of the British Association of Plastic, Reconstructive and Aesthetic Surgeons, identified patients with complications resulting from cosmetic surgery abroad. A case series spanning the years between and described the outcomes of 26 patients undergoing a variety of cosmetic and bariatric surgical procedures abroad that all culminated in patient death.
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Kantak and colleagues report a case of a patient undergoing bilateral breast augmentation surgery abroad who presented with mastalgia and breast firmness from a gossypiboma secondary to a retained surgical sponge 7 months after breast augmentation surgery.
Table 2. Summary of cosmetic surgical tourism procedures and complications. Non-tuberculous rapidly growing mycobacteria NT-RGM are an emerging pathogen group that has become increasingly more common in patients seeking surgical cosmetic procedures abroad. NT-RGM acquired through direct inoculation can affect cutaneous tissue; however pulmonary infections with the pathogen can occur with patients with pre-existing lung disease and disseminated infections have been identified in immunocompromised patients.
The three clinically relevant species of NT-RGM associated with cosmetic surgery are Mycobacterium chelonaeMycobacterium fortiutum and Mycobacterium abscessus.
A retrospective analysis that focused on cosmetic surgery-related mycobacterial infections presenting between and 5 35 identified three patients, two of whom had undergone breast augmentation surgery in the Dominican Republic and Mexico and presented with unilateral and bilateral breast abscesses that were positive for M.
Cusumano and colleagues identified 4 patients returning from elective cosmetic surgery in the Dominican Republic between August and Junewith laboratory-confirmed M. Multivariate analysis of returned travellers hospitalized in Finland identified invasive surgical procedures abroad and travel to tropical rather than temperate zones as independent risk factors for colonization with multidrug-resistant bacteria.
The risks associated with receiving blood transfusions during international travel are well recognized among travel medicine practitioners and should serve as a reminder to intending surgical tourists about the need for careful consideration of the services offered by their host clinical facility abroad.
It is likely that the field of cosmetic surgical tourism will increase in popularity in the future. There is considerable uncertainty with regard to the number of patients seeking cosmetic surgery abroad. This review aimed to identify the impact of patients seeking cosmetic surgery abroad and the complications associated with these procedures. It is difficult to determine the significance of these complication rates without valid comparisons to the equivalent domestic complication statistics.
Furthermore, the available data collected are displayed in a non-standardized way, making them difficult to compare. Websites which provide information regarding medical tourism may minimize the risks of clinical interventions in international jurisdictions 41 ; this was reported previously in relation to stem cell tourism.
Increasing travel for invasive aesthetic surgery necessarily leads to patients travelling to disease-endemic regions without the necessary pre-travel health preparation, adding to the risk of morbidity and illness in returning tourists. Prior to undertaking surgery abroad, patients may only be counselled by a company representative and not by a clinical gatekeeper or surgeon. Informed consent can only be truly obtained once the details of the surgical procedure, risk, outcomes and cost have been discussed.
The American Society of Plastic Surgeons have included on their website information regarding, risk, follow-up care and aspects of travel prior to engaging in surgery abroad.
Over the last 10 years, multiple studies have identified post-cosmetic surgical tourism complications. In the majority of cases, there was a lack of a medical care plan, accountability and legal protection framework should complications manifest. The medicolegal risks of travel medicine practice have been discussed previously in this journal. From a surgical cosmetic tourism standpoint, one means of alton towers ride crash smiler the risk of postoperative complication once patients have successfully undergone surgery would be to record a standardized minimum data set at the time of surgery.
This form can then be taken by the patient and, should complications arise, the treating physicians would have access to operative and implant details.
This could improve resource allocations, time to diagnosis and overall morbidity and mortality of the patient. In conjunction with this, surgical tourism destinations should maintain a clinical quality register. Table 3. Travel health recommendations for cosmetic surgical tourists. Bring a copy of your medical records, family doctor contact details and prescription when travelling overseas.
Observe general travel health precautions regarding food and water, insect bites, animal bites, sexual activity and personal safety. A limitation encountered by this review is that the studies identified are of low methodological quality within the hierarchy of evidence, data collected in these studies were not uniform and varied in terms of information sources. The surveys in the study had a poor response rate and not all studies discussed cosmetic surgical outcomes as their principal focus.
Although motivations for patients to seek cosmetic surgical procedures abroad are well documented, information regarding demographics and awareness of surgical tourism are few. This review focused on a narrow aspect of medical tourism, cosmetic surgery. Broadly speaking, the issues relating to complications, lack of continuity of care and informed consent may be common across many different medical and surgical specialties.
The literature on psychological screening of cosmetic surgical tourists and the mental health sequelae of cosmetic surgery is sparse.
This would be a fertile area of research among surgical tourists, whose dissatisfaction with their appearance or body shape may be exacerbated by limited follow-up care when they return to their home country. Alia and colleagues advocate the use of reverse innovation as a mechanism for developing global medical tourism partnerships.
Further research may specifically explore this concept in relation to cosmetic surgery tourism. Had liposuction done on the stomach area.
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