A Systematic Review of the Use of Telemedicine in Plastic and Reconstructive Surgery and Dermatology. 2017

Krishna S Vyas, and H Rhodes Hambrick, and Afaaf Shakir, and Shane D Morrison, and Duy C Tran, and Keon Pearson, and Henry C Vasconez, and Samir Mardini, and Amanda A Gosman, and Marek Dobke, and Mark S Granick
From the *Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, MN; †New York University School of Medicine, New York City, NY; ‡Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, CA; §Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, WA; ∥Stanford University School of Medicine, Stanford, CA; ¶Division of Plastic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY; #Division of Plastic Surgery, Department of Surgery, University of California San Diego, San Diego, CA; and **Division of Plastic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ.

BACKGROUND Telemedicine, the use of information technology and telecommunication to provide healthcare at a distance, is a burgeoning field with applications throughout medicine. Given the visual nature of plastic surgery and dermatology, telemedicine has a myriad of potential applications within the field. METHODS A comprehensive literature review of articles published on telemedicine since January 2010 was performed. Articles were selected for their relevance to plastic and reconstructive surgery and dermatology, and then reviewed for their discussion of the applications, benefits, and limitations of telemedicine in practice. RESULTS A total of 3119 articles were identified in the initial query. Twenty-three articles met the inclusion criteria in plastic surgery (7 wound management, 5 burn management, 5 trauma, 4 free flap care, 2 in cleft lip/palate repair). Twenty-three (100%) reported a benefit of telemedicine often related to improved postoperative monitoring, increased access to expertise in rural settings, and cost savings, either predicted or actualized. Eight (35%) reported limitations and barriers to the application of telemedicine, including overdiagnosis and dependence on functional telecommunication systems. Sixty-six articles focused on telemedicine in dermatology and also demonstrated significant promise. CONCLUSIONS Telemedicine holds special promise in increasing the efficiency of postoperative care for microsurgical procedures, improving care coordination and management of burn wounds, facilitating interprofessional collaboration across time and space, eliminating a significant number of unnecessary referrals, and connecting patients located far from major medical centers with professional expertise without impinging on-and in some cases improving-the quality or accuracy of care provided. Teledermatology consultation was found to be safe and has a comparable or superior efficacy to the traditional in-patient consultation. The system was consistently rated as convenient and easy to use by patients, referring physicians, and consulting dermatologists. Teledermatology has also been used as an educational tool for patients. A significant number of studies detailed strategies to improve the current state of teledermatology, either by implementing new programs or improving technologies. Telemedicine use is widespread among plastic surgeons and is enabling the spread of expertise beyond major medical centers. Further research is needed to conclusively demonstrate benefit in routine clinical care.

UI MeSH Term Description Entries
D003880 Dermatology A medical specialty concerned with the skin, its structure, functions, diseases, and treatment.
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013518 Surgery, Plastic The branch of surgery concerned with restoration, reconstruction, or improvement of defective, damaged, or missing structures. Cosmetic Surgery,Esthetic Surgery,Plastic Surgery,Surgery, Cosmetic,Surgery, Esthetic,Reconstructive Surgery,Surgery, Reconstructive
D017216 Telemedicine Delivery of health services via remote telecommunications. This includes interactive consultative and diagnostic services. Tele-Care,Tele-ICU,Tele-Intensive Care,Tele-Referral,Telecare,Virtual Medicine,Mobile Health,Telehealth,eHealth,mHealth,Health, Mobile,Medicine, Virtual,Tele Care,Tele ICU,Tele Intensive Care,Tele Referral,Tele-Referrals
D019651 Plastic Surgery Procedures Procedures used to reconstruct, restore, or improve defective, damaged, or missing structures. Cosmetic Reconstructive Surgical Procedures,Cosmetic Surgical Procedures,Esthetic Reconstructive Surgical Procedures,Esthetic Surgical Procedures,Plastic Surgical Procedures,Reconstructive Surgical Procedures,Reconstructive Surgical Procedures, Cosmetic,Cosmetic Reconstructive Surgery,Procedure, Reconstructive Surgical,Procedures, Reconstructive Surgical,Reconstructive Surgical Procedure,Reconstructive Surgical Procedures, Esthetic,Surgical Procedure, Reconstructive,Surgical Procedures, Reconstructive,Cosmetic Reconstructive Surgeries,Cosmetic Surgical Procedure,Esthetic Surgical Procedure,Plastic Surgery Procedure,Plastic Surgical Procedure,Procedure, Cosmetic Surgical,Procedure, Esthetic Surgical,Procedure, Plastic Surgery,Procedure, Plastic Surgical,Procedures, Cosmetic Surgical,Procedures, Esthetic Surgical,Procedures, Plastic Surgery,Procedures, Plastic Surgical,Reconstructive Surgeries, Cosmetic,Reconstructive Surgery, Cosmetic,Surgeries, Cosmetic Reconstructive,Surgery Procedure, Plastic,Surgery Procedures, Plastic,Surgery, Cosmetic Reconstructive,Surgical Procedure, Cosmetic,Surgical Procedure, Esthetic,Surgical Procedure, Plastic,Surgical Procedures, Cosmetic,Surgical Procedures, Esthetic,Surgical Procedures, Plastic

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