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A Systematic Review of the Use of Telemedicine in Plastic and Reconstructive Surgery
Krishna S. Vyas, MD, PhD, MHS1, Rhodes H. Hambrick, BS2, Afaaf Shakir, BS3, Shane D. Morrison, MD, MS4, Amanda A. Gosman, MD5, Marek Dobke, MD, PhD5, Henry C. Vasconez, MD6, Samir Mardini, MD1, Mark S. Granick, MD7.
1Mayo Clinic, Rochester, MN, USA, 2New York University, New York City, NY, USA, 3Stanford University, Palo Alto, CA, USA, 4University of Washington, Seattle, WA, USA, 5University of California San Diego, San Diego, CA, USA, 6University of Kentucky, Lexington, KY, USA, 7Rutgers New Jersey, Newark, NJ, USA.

PURPOSE: 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, 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 then reviewed for their discussion of the applications, benefits, and limitations of telemedicine in practice.
RESULTS: A total of 2291 English language articles were identified from the initial PubMed query. Twenty-three articles met the inclusion criteria (7 wound management, 5 burn management, 5 trauma, 4 free flap care, 2 in cleft lip/palate repair). Of note, all 23 articles reviewed emphasized the benefits, either potential or actualized, of telemedicine in plastic surgery, highlighting increased opportunities for post-operative monitoring, reductions in the number of unnecessary clinic visits, cost savings, decreased response times for referrals, improvements in triage decisions, novel avenues for surgical education, and increased access to specialist care in rural and low-resource settings. Limitations of and barriers to the use of telemedicine were discussed in eight of the articles, which discussed the need for intact telecommunication systems, which may not be available in natural disasters or other exigent situations, experts’ inability to accurately assess certain parameters, like burn depth, by photograph alone, the barrier to effective communication in live teleconferencing posed by delays in video transfer and lapses in video resolution, the ethical uncertainties and privacy concerns introduced by novel technologies, and the reality that, when uncertain, providers acting at a distance may tend to overestimate a condition’s severity, potentially resulting in unnecessary treatment or procedures.
CONCLUSIONS: Telemedicine is a rapidly growing aspect of medicine that offers improved access, cost efficiency, and quality healthcare services. 21st-century technology has produced telemedical advancements that provide a worthy adjuvant to the toolkit of the plastic surgeon. However, a need still exists for high-quality evidence to demonstrate clear, and reproducible benefits of telemedicine in routine clinical practice. Further refinements in photo and video resolution, internet connectivity, data encryption, and smartphone applications will increase the accuracy and utility of telemedicine to the plastic surgeon.


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