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Frontal three-dimensional reconstruction of the human cadaver recipient before transplantation, after transplantation, planned outcome, and donor before transplantation. Note the sites of rigid fixation in a Le Fort–based face-jaw-teeth transplantation. The red dots denote the measured landmark positions in each model (below). IMAGES REPRODUCED FROM: MURPHY RJ, ET AL. PLAST RECONSTR SURG 2015 Plastic and Reconstructive Surgery | 7 8 Urogenital Transplant Following the success of their upper extremity reconstructive transplants, faculty members began planning to transplant a penis—something that has been attempted only twice in the world. In particular, they were hoping to benefit soldiers injured by roadside bombs, who sometimes experience damage in pelvic areas not covered by traditional body armor, and who often sustain such extensive additional injuries that surgeons are hard-pressed to find the donor sites necessary for conventional penile reconstruction. But the literature indicated that after a penis is sewn back on following a traumatic cut, the penis generally survives, but the skin dies. Enter resident physician Sami Tuffaha, whose untold hours studying the problem in the lab were rewarded by the discovery of a previously unknown blood vessel leading from the femoral artery to supply the shaft skin. “When there’s so much tissue, you need this vessel to make it work. No one knew this vessel even existed two and a half years ago,” says Richard Redett, director of the Pediatric Plastic and Reconstructive Surgery and Johns Hopkins Cleft Lip and Palate Center. Armed with this new finding, Redett’s 15 years of experience doing complex urogenital reconstructions on children, the promise of minimal immunosuppression and perhaps the most experienced reconstructive transplant program in the country, faculty members have been practicing all the details of the procedure. With the collaboration of specialties, including urology, psychiatry and psychology, bioethics, and transplant immunology, the team hopes to complete the first penile transplant in the near future. “You can only imagine the impact a penile amputation would have on a young man in his early 20s, who’s been serving overseas and returns from service to the civilian world and all prospects of a normal social and sexual life have been taken away from him,” says reconstructive surgeon Damon Cooney. “We want to do whatever we can to help him return to manhood and wholeness, and also urinary and sexual function.” “We want to do whatever we can to help him return to manhood and wholeness, and also urinary and sexual function.” Illustration depicting penile transplantation ILLUSTRATION BY TIM PHELPS Trauma Center Expertise: microvascular reconstruction; adult and pediatric craniofacial surgery for congenital, oncological and traumatic conditions; facial reanimation; orthognathic surgery; aesthetic facial plastic surgery Accomplishments: House of D Outcomes Research in Facial Plastic Surgery: A Review and New Directions Ramsey Alsarraf, M.D., M.P.H. Seattle, Washington, USA Abstract. Outcomes research is a fast-growing field of study that focuses on patient-related aspects of medical or surgical outcomes such as satisfaction and quality of life. In the realm of facial plastic surgery, many outcomes are subjective evaluations based on the patient and physician’s judgment as to the surgical result, but little has been done to quantify these qualitative results in an objective manner. This paper discusses the basis for outcomes research and suggests its application to the field of facial plastic surgery. Four new facial plastic outcomes instruments have been developed and are provided for the potential use in measuring the quality of life results of rhytidectomy, rhinoplasty, blepharoplasty, and skin rejuvenation procedures. Key words: Outcomes research—Facial plastic surgery— Quality of life “. . . plastic surgeons have arrived at a vital crossroads. By taking an active part in outcomes research and in . . . health-care policy . . . we can assist in keeping medical decisions where they belong—in the hands of patients and their physicians” [1]. Outcomes research is characterized by the evaluation of the patient-related results of medical interventions, with an emphasis on both the effectiveness of outcomes in terms of patient satisfaction or quality of life, and the costs of attaining these positive results [2,3]. There has been an increasing interest in this form of outcomes evaluation in many of the surgical subspecialties in the last decade. For instance, in Otolaryngology-Head and Neck Surgery, outcomes research has primarily been the focus of the field of head and neck oncology or specific illnesses such as otitis media, acute sinusitis, or obstructive sleep apnea [4–8]. However, there are few specific outcomes studies in the field of facial plastic and reconstructive surgery, despite the fact that patient satisfaction is the ultimate goal of most facial plastic surgery procedures. Wilkins et al. [1] have highlighted the importance of outcomes research for the plastic surgeon, yet there is little evidence that the quantification of the costs and effectiveness of plastic surgery procedures has been further emphasized in recent years. The outcomes of any surgical procedure can be defined in a myriad of ways. Surgical results may be measured in quantitative or qualitative terms. Unlike the realm of head and neck oncology, measurements such as the morbidity or mortality of a given intervention mean little in the field of facial plastic surgery, where many procedures are elective or cosmetic in nature. Often the only means of assessing outcome in this setting is the subjective analysis of the patient as well as the evaluation of the operating surgeon. Thus, in many cases the facial plastic surgeon is left with no quantitative evaluation of the results of his or her procedure. This lack of quantitative data makes comparing different techniques difficult. Similarly, it may be difficult for different surgeons to compare their results when each is measuring surgical outcome by his or her own subjective endpoints. In facial plastic and reconstructive surgery, particularly aesthetic facial plastic surgery, patient satisfaction remains the yardstick by which a successful surgical outcome is measured. A given surgeon may be satisfied with his or her results, but if the patients themselves are not similarly pleased then the intervention cannot totally be considered a success. Certainly there are various aspects of each individual patient’s character and personality that will influence his or her own assessment of the surgical outcome. However, in a population of patients one would expect that patient satisfaction should define the success of a series of procedures. This paper reviews the basic foundations of outcomes Correspondence to author at Department of OtolaryngologyHead and Neck Surgery, University of Washington School of Medicine, Seattle, WA 98195, USA Aesth. Plast. Surg. 24:192–197, 2000 DOI: 10.1007/s002660010031 © 2000 Springer-Verlag New York Inc. research and evaluates the application of these concepts to the field of facial plastic surgery. In order to provide a framework for further studies focusing on patientrelated outcomes, several new procedure-specific quality of life instruments have been developed and are provided for the reader to use in his or her own practice. Outcomes Research: Background All surgeons are interested in patient outcomes. Outcomes research is the field of study that focuses on these results in terms of patient-related measures such as satisfaction, functionality, and quality of life, rather than solely traditional clinical measures of treatment efficacy [1–3]. In contrast to clinical trials, outcomes research applies new methods of measuring and validating the subjective experience of the patient in order to determine the effectiveness of a given procedure in the real-life setting [9]. Several studies in recent years have evaluated patient-related outcomes for a variety of
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