Telemedicine applied to plastic surgery: an integrative review

Borges, Kênya de Souza; Oliveira, Valter Oberdan Borges de; Cavalcante Filho, João Batista; Simões, Sílvia de Magalhães; Oliveira, Adicinéia Aparecida de; Lima, Carlos Anselmo

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Cirurgia Plástica

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Article • Rev. Bras. Cir. Plást. 36 (2) • Apr-Jun 2021 • https://doi.org/10.5935/2177-1235.2021RBCP0066 copy

Telemedicine applied to plastic surgery: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Telemedicine refers to providing medical services through information technology and communication between patients and service providers. Plastic surgery is a field especially favorable to the application of telemedicine since visual inspection of the patient guides both diagnosis and clinical follow-up.

Methods:

An integrative review was performed in the articles published in telemedicine in plastic surgery in the PubMed database, using the terms MeSH: “telemedicine” AND “plastic surgery.” After tracking and applying eligibility criteria, the remaining articles’ full text were digitized, with their data extracted for detailed analysis.

Results:

A total of 134 articles were identified, all in English, in the initial search for PubMed. After screening and application of the exclusion criteria, 12 studies were included for the integrative review. The articles found in this review demonstrated benefits in the use of telemedicine applied to plastic surgery. Especially in the postoperative follow-up of patients, in the reduction or extinction of the need for face-to-face visits, in the satisfaction of patients in the consultations carried out by telemedicine, in the reduction of financial costs and response time for referrals, in the diagnostic accuracy similar to the face-to-face assessment and in improving access to specialized care in remote places, both geographically and socially unfavorable. Four articles discussed barriers and limitations, observed or potential, to the use of telemedicine in plastic surgery, such as data security, legislation, costs and perception of negative influence on doctor-patient communication.

Conclusion:

The analyzed studies show an expressive gain in knowledge about telemedicine applied to plastic surgery in recent years.

Keywords:
Telemedicine; Plastic surgery; Telesurgery; Patient care; Review

Reference (Year), Country	Primary Objective	Methods	Findings	Conclusions
Douglas et al.¹1 Douglas S, Geiger E, McGregor A, Norwich A, Abbate D, Hsia H, et al. Telehealth in plastic surgery: a veteran's affairs hospital perspective. Plast Reconstr Surg Glob Open [Internet]. 2018 Out; 6(10):e1840. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/30534478 https://www.ncbi.nlm.nih.gov/pubmed/3053... (2018), United States	Review the video teleconsultation (VTC) experience in the Connecticut VA health system and research patients' attitudes toward telemedicine services in this context.	Cross-sectional study through the application of qualitative and quantitative questionnaires to assess patient satisfaction with the medical service.	In a score scale that goes up to 10 points, patients positively evaluated the overall quality of interaction with their physician (note: 9.2), their ability to communicate (note: 9.3) and their overall satisfaction (note: 9.2). Patients classified video and sound quality with grades 8.6 and 9.0, respectively. 83% stated that they would prefer the consultation of telehealth to personal visits for future plastic surgery problems, and 7 patients (17%) said they would prefer a personal visit.	Live interactive telemedicine consultation with a plastic surgeon in the VA health care system results in substantial patient satisfaction with the convenience of accessing medical care in remote communities.
Funderburk et al.²2 Funderburk CD, Batulis NS, Zelones JT, Fisher AH, Prock KL, Markov NP, et al. Innovations in the plastic surgery care pathway: using telemedicine for clinical efficiency and patient satisfaction. Plast Reconstr Surg [Internet]. 2019 Ago; 144(2):507-16. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/31348369 https://www.ncbi.nlm.nih.gov/pubmed/3134... (2019), Lebanon	Develop a process of clinical efficiency improvement and offer optimal patient satisfaction, in the postoperative scenario, through a technical health tool.	Patients living in a predefined area were given the option of monitoring by telehealth and follow-up for 1 year. Cosmetic surgeries were excluded.	Preoperative studies revealed that 73% of patients preferred follow-up visits in person, while satisfaction after the meeting by telehealth was 95%. 96% of patients said they had their questions answered and 97% would use the service again.	Telemedicine is associated with increased patient satisfaction and potentially improved clinical outcomes, without prejudice to follow-up.
Pozza et al.⁷7 Pozza ED, D'Souza GF, DeLeonibus A, Fabiani B, Gharb BB, Zins JE. Patient satisfaction with an early smartphone-based cosmetic surgery postoperative follow-up. Aesthet Surg J [Internet]. 2017 Dez; 38(1):101-9. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/29117293 https://www.ncbi.nlm.nih.gov/pubmed/2911... (2017), UNITED STATES	Evaluate the effectiveness of a smartphone-based plastic surgery postoperative follow-up program.	Retrospectively reviewed, during the period of 1 year, the clinical records of patients undergoing cosmetic surgeries of the face, as well as data from questionnaires and postoperative photographs sent by patients' smartphones.	50 (96,2%) patients reported that the process improved the quality of their postoperative experience. The protocol allowed the detection of early complications in 3 cases, but complications were detected outside the deadline stipulated for early submission of photographs.	The plastic surgeon can provide virtually early postoperative patient surveillance. Although early photography failed to identify complications, they were detected by later photographs.
Westra et al.⁸8 Westra I, Niessen FB. Implementing real-time video consultation in plastic surgery. Aesthetic Plast Surg [Internet]. 2015 Out; 39(5):783-90. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/26169952 https://www.ncbi.nlm.nih.gov/pubmed/2616... (2015), Netherlands	Investigate whether online consultation is a satisfactory alternative to traditional face-to-face consultation in the postoperative period of face-to-face plastic surgery.	Randomized clinical trial with inclusion of eligible patients in two 6-week postoperative evaluation arms: face-to-face consultation or video consultation, with subsequent completion of scientifically validated questionnaires (PSQ-18, PEQ and TSQ) of satisfaction and evaluation of doctor-patient communication	31 patients participated. Overall satisfaction was the same in both groups, but there was a significant difference in the dimensions "general satisfaction" (online most satisfied consultation group, P=0.02) and "accessibility and convenience" (less satisfied online consultation group, P=0.01) in the PSQ-18 questionnaire.	Patients were also satisfied with traditional or real-time video consultation in plastic surgery. Online consultation is considered a time-saving alternative to traditional consultation, although it may be perceived by some patients as a negative influence on communication with the doctor.
Rimal et al.¹⁴14 Rimal D, Huang-Fu JH, Gillett D. Our experience in using telehealth for paediatric plastic surgery in Western Australia. ANZ J Surg [Internet]. 2017 Abr; 87(4):277-81. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/28219124 https://www.ncbi.nlm.nih.gov/pubmed/2821... (2017), Australia	Share the experience of authors using technology for the provision of services and care in a geographically challenging environment	Retrospective study of data from patients' medical records for a period of 1 year, including all patients registered in the plastic surgery technical service.	194 rural patients (66 men and 128 women), 26 of whom were elective cases and 358 follow-up visits in telehealth. 10 patients were treated only via telehealth; 24 patients had their first face-to-face clinical review and additional follow-up via telehealth, and 99 patients were postoperative. The etiology of cases ranged from skin lacerations to complex soft tissue and bone lesions, as well as elective cases of postoperative craniofacial follow-up of the hands.	Telemedicine in plastic surgery can also be used in the pediatric population, especially in remote locations, with minimal access to specialists.
Sood et al.17 (2016), France	Analysis of the wound treatment system by telemedicine.	Review of data from the CICAT network (Home Hospital Healing Network), including 5,794 patients, between January 2005 and October 2015. Clinical efficacy and medical-economic results were analyzed.	In the experience of the CICAT wound network, the results showed that 75% of the wounds improved or healed, a 72% reduction in the number of hospitalizations and a 56% reduction in ambulance transfers to healing centers.	Telemedicine can be beneficial in the treatment of wounds, although it is important to note that in some countries legal restrictions can make telemedicine extremely complicated.
Rennekampff et al.19 (2015), Germany	Examine the intra- and inter-examiner variability of remote photographic wound closure analysis, as well as the reliability of remote photographic wound analysis with direct clinical evaluation.	Blind analysis by panel of high-resolution image evaluators from two randomized clinical trials. The validity of the photographic image analysis was correlated with clinical evaluations of the time for recovery.	The mean intraclass correlation coefficient of the four examiners was excellent (r = 0.79; 95% confidence interval (CI), 0.61, 1.00). The correlation coefficient between evaluators was good (r = 0.67; 95%, 0.57, 1.00)). The agreement between remote visual evaluation and clinical evaluation at the time of healing was good (r = 0.64; 95%, 0.52, 0.76)).	Remote photographic analysis of skin wounds is a viable tool in clinical studies to assess the time to wound closure.
Hughes et al.15 (2017), USA and Ecuador	To evaluate the reliability of remote digital video in the preoperative diagnosis of cleft lip and palate in environments with few resources in rural Ecuador, as well as to evaluate the possible economic gains generated with the adoption of this technology.	Retrospective analysis of video data during preoperative evaluations by a craniofacial surgeon in patients in February 2015, with classification of each patient with the same objective criteria. Analysis of the percentage of agreement between the two groups and the reliability among evaluators.	A 95.7% agreement was found among the observers for cleft lip, with substantial reliability (k = 0.78, P< 0.01). There was agreement of 82.6% among the observers for cleft palate, with moderate reliability (k=0.55, P< 0.01). We found agreement of 47.8% among the observers for alveolar cleft, with a weak and non-significant kappa agreement.	Remote digital evaluations are a reliable way to diagnose labial and palatine cleft preoperatively in the context of interventions in plastic surgeries in low- and middle-income countries.
Martinez et al.16 (2017), South Africa	Evaluate the WhatsApp application to facilitate burn treatment and resource allocation.	Review of all queries that used WhatsApp for 18 months, received by two senior doctors from a burn center	833 communications and 1562 clinical doubts were evaluated. 486 interactions (58%) from inside the hospital. There was no change in the number of surgical interventions, but they reduced outpatient consultations.	WhatsApp has contributed to the reduction of unnecessary referrals and outpatient consultations.
Cai et al.18 (2016), Nepal and USA	Test the reliability of the Patient and Observer Scar Assessment Scale (POSAS) using videoconferencing.	Prospective study conducted with three independent observers. They evaluated 85 burn scars from 17 individuals.	Reliability for single evaluator was acceptable (ICC> 0.70). The reliability of the mean of the three evaluators was acceptable (ICC> 0.70). In the general opinion score, patients consistently reported worse opinion.	Evaluation of burn scars using the POSAS scale can be accurately performed through videoconferencing.
Boccara et al.26 (2018), France	Evaluate the quality of method for telemedicine.	Retrospective study with 323 patients. The purpose of using telemedicine was to evaluate the need for surgery.	Correct initial diagnosis in 94.4% (305/323) of cases. Eleven patients (3.4%) were transferred unnecessarily and seven patients (2.2%) were not transferred, despite the need for surgery.	The results encourage the development of telemedicine based on digital photography, although it never replaces clinical examination.
Paik et al.²⁵25 Paik AM, Granick MS, Scott S. Plastic surgery telehealth consultation expedites Emergency Department treatment. J Telemed Telecare [Internet]. 2017 Fev; 23(2):321-7. Disponível em: https://www.ncbi.nlm.nih.gov/pubmed/27056907 https://www.ncbi.nlm.nih.gov/pubmed/2705... (2016), UNITED STATES	Evaluate the response of telehealth through an application for consultations related to plastic surgeries.	Quality Assurance/Improvement Study of a trauma center. The study used an application to send images and brief history to plastic surgery teachers.	42 consultations performed. The agreement between teachers and consultants was 85.7% for face-to-face consultations and 100% for telephone consultations. In four cases of telephone consultations, emergency department providers incorrectly placed splints on injured patients.	The results show that telehealth consultations were able to produce timely and accurate responses in an emergency care unit.

Sociedade Brasileira de Cirurgia Plástica Rua Funchal, 129 - 2º Andar / cep: 04551-060, São Paulo - SP / Brasil, Tel: +55 (11) 3044-0000 - São Paulo - SP - Brazil
E-mail: rbcp@cirurgiaplastica.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author:Kênya de Souza Borges Avenida Doutor José Machado de Souza, 220, Sala 304, Ed. Neo Office, Jardins, Aracaju, SE, Brazil. Zip Code: 49025-740. E-mail: kenyaborges08@yahoo.com.br