Outpatient Plastic Surgery

Subspecialties are a worldwide reality. Plastic sut;gery) as a specialty) is increasingly subdividing. This paper refers to outpatient sectm; making comments on it and emphasizing some requirements and advantages ofthis type ofprocedure. Outpatient Plastic Surgery is defined as the surgery branch that acts on surgical reparation of acquired de­ fects or congenital deformities as well as aesthetic-or­ der disharmony of which interventions may be per­ formed in an outpatient basis. It is divided into large outpatient surgery, performed in non-hospitalized pa­ tients, under any type of anesthesia and which requires a postoperative observation or recovery period with same-day dismissal, and short outpatient surgery, per­ formed under local anesthesia, with immediate dismissal of patient(l). Simplification ofsurgical procedures aiming at decreas­ ing costs, but at all times observing basic safety prin­ ciples(l) guides outpatient plastic surgery. Risk limits of an outpatient procedure may be increased and complicated, thus the need for a good hospital structure, i.e., minimal-condition surgical environment: wash-basin, operating room equipped with operating table and proper material, light spot, aspirator, cautery knife, serum support, negatoscope, oxygen and resus­ citation equipment (laryngoscope, oro tracheal intuba­ tion cannulas, and mechanical respirator) (2). An ad­ equate case by case preoperative assessment by anes­ thetist and surgeon is the first step to warranty more safety. The anesthetist is concerned with anesthetic in­ dication, the patient's psychological profile, and the assessment of the operation extension; and renders more intensive anesthetic care for ASA *2 (controlled systemic diseases) and 3 (hard-compensation systemic disorders) patients. The use of new drugs such as Etomidate, Propofol, Ropivacaine; inhalants, such as Sevoflurane, Isoflurane, and Alphentanyl­ Sulphentanyl-type opioids, provides a more soothing surgery and a postoperative period with the lowest complication rates and the possibility ofearly dismissal. Outpatient surgical procedures are primary and highly important as they are paramount for the patient under risk situations. Airway maintenance and surgical venous pathways must be at the surgeon's reach(3). Rev. Soc. Bras. Cir. Plast. Sao Paulo v.16 n.3 p. 71-74 set/dez. 2001 . 71 Revista da Sociedade Brasileira de Cirurgia Phistica Some of the main pathologies treated on an outpa­ tient basis in plastic surgery are: 1 Skin and adnexa affections (lipomas, nevus, epithelial benign and ma­ lign neoplasias, pathological scars); 2 Hands (syn­ ovial cyst, hangnail, tenosynovitis, traumas with par­ tial amputations); 3 Perineal region (sacrococcygeus pilonidal cyst, small pudenda lip hypertrophy, soft portion tra uma); 4 Face (nasal, palpebral, ears, craniomaxillofacial, congenital and acquired deformi­ ties); 5 Mamma (hypomastia, mammary ptosis, mammary and mammilla changes, gynecomast:y); 6 ­ Body contour (body lipodystrophy, congenital and acquired deformities); 7 Scalp (alopecia, tumors, scars) (2) . With the advent of new techniques and technologies, outpatient procedures gained allieds such as Laser, Botulinwn Toxin(4) and aloplastic material implants, among others, which provide an important improve­ ment of the patient's life quality(S). Despite progresses achieved, and sometimes questioned laser, for in­ stance, as technique associated to surgery, "has become a great business or an advance in sciences" nowadays? (6) the modification input are welcome, provided proven benefits are achieved(7) . It is important to further observe outpatient plastic surgery on a practical way, under better pre-, intra­ and postoperative conditions. In any situation, cor­ rect diagnosis and a good physician-patient relation­ ship is fundamental . Joint assessment with anesthetist is required on the preoperative period, giving the patient answers to his/ her doubts and focusing on his/her own needs in or­ der to a calm procedure to take place. Sedation need must be assessed during intraoperative period (as much as preoperative) as well as a quick procedure so minimum time and greater resolubility are achieved. Permanent field re-evaluations must be made in (immediate and late) postoperative period in addition to following-up the patient's overall condi­ tions. Dismissal may be accelerated with the aid of modern medications. Also greatly important is phone contact and ambula­ tory proximity to a medical center for any event, which contributes to surgery safety and full success. Outpatient plastic surgery is increasingly a reality pre­ senting a number of advantages in some cities both for the physician and the patient, among which are short hospital stay, resulting in lower hospital infec­ tion risk; procedure lower cost, faster and uncompli­ cated postoperative recovery with less nausea and vom­ iting and other common inconveniences to conven­ tional hospital surgery.