Role of telemedicine in hand injuries requiring plastic surgery
Date First Published:
August 11, 2007
Last Updated:
August 28, 2007
Report by:
Muhammad Umair Javed, Foundation Year 2 (Blackpool Victoria Hospital)
Search checked by:
Jon Argall, Blackpool Victoria Hospital
Three-Part Question:
In [a patient with hand injuries] is [telemedicine valuable] in [referrals to regional plastic surgery centre].
Clinical Scenario:
A 50 year old man presents to accident and emergency department after an assault and has injuries to his hand. On examination you are not sure if it needs plastic surgery, you try your best to relay the relevant information to plastic surgeon in the regional centre and transfer the patient to the centre. At the centre he is evaluated and it is found that he does not need plastic surgery. Could we have avoided this scenario by using teleconsultation.
Search Strategy:
MEDLINE 1950-06/2007 using the OVID Interface
[(telemedicine.mp. or exp telemedicine) AND (wound.mp. or exp wound and injuries)] LIMIT to
humans and English and Core Clinical Journals.
[(telemedicine.mp. or exp telemedicine) AND (wound.mp. or exp wound and injuries)] LIMIT to
humans and English and Core Clinical Journals.
Search Details:
[(telemedicine.mp. or exp telemedicine) AND (wound.mp. or exp wound and injuries)] LIMIT to
humans and English and Core Clinical Journals.
humans and English and Core Clinical Journals.
Outcome:
A total of 8 papers were found by Medline search. 3 papers had relevance to our clinical question. 1 more was found by cross referencing the papers.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Teleconsultation with the mobile camera phone in digital soft tissue injury: a feasibility study. Hsieh, Ching-Hua. Tsai, Hui-Hong .Yin, Jer-Wen, et al 2004 Taiwan | Teleconsultation of 45 patients with 81 digital injuries was made using mobile camera phone. Male 34, female 11. Age range 15-54 |
Prospective cohort study | The patients were triaged in to three groups;Group I: Primary closure.Group II: Local flap coverage.Group III: Microsurgery | 79% sensitivity and 71% specificity in remote diagnosis of skin defect. 76% sensitivity and 75% specificity in remote identification of bone exposure. In 12 (15%)cases there was disagreement of triaging. | No statistical power. Triage did not identify tendon injuries. |
| Time for E consultation | The mean operation time for consultation was 3-4 minutes. | ||||
| Telemedicine in plastic surgery: E-consult the attending surgeon. Pap, Stephen A. Lach, Elliot. Upton, Joseph 2002 USA | 20 Patients evaluated over 6 weeks. 12 hand injuries. 8 soft tissue injuries. Consultations were done using digital camera |
Case series | Out of 20 E consultations | 1 patient had reimplantation attempt. Generated an algorithm. | Small number of patients. Convenience study. Biased. |
| Attending surgeons reported thorough satisfaction with picture quality ,speed of transmission and screen resolution | Consult Email generated in less then 10 mins and received by attending Physician in less then 5 minutes. There were no delays. Photo resolution was satisfactory. | ||||
| Time for E consultation | |||||
| Initial plastic surgery experience with the first telemedicine links for the British Forces. Scerri,G. and Vassallo, D.J. 1999 British Journal Of Plastic Surgery | 133 telemedicine referrals were made over 16 months which included images of xrays, of patients wounds, of ECGS,of burn injuries, of skin and eye lesions and of blood films througha microscope. |
Case Reports | 11 plastic surgery referrals were made. | 9 underwent surgery. 2 were managed conservatively. | |
| Image quality. | Images were reliably diagnostic. Patient confidentiality was preserved by the use of code numbers for each patient. | ||||
| Time for E consultation | 15 seconds to 2 minutes | ||||
| Using the internet for rapid exchange of photographs and X ray images to evaluate potential extremity replantation candidates. Buntic, R F. Siko, P P. Buncke, G M, et al. 1997 USA | Teleconsultation of a single patient was made using high resolution camera. | Case Report | E consultation of 1 patient was made | Reimplantation was successful |
Author Commentary:
The work done in these studies clearly show the benefit of telemedicine in assessment of hand injuries which may require specialist plastic surgery input.
Cost effectiveness and confidentiality/security needs appraisal.
It is safe and easy to use.
It reduces unnecessary referrals and transfer of patients, potentially saves money and improves clinical acumen of the Accident and Emergency residents
Cost effectiveness and confidentiality/security needs appraisal.
It is safe and easy to use.
It reduces unnecessary referrals and transfer of patients, potentially saves money and improves clinical acumen of the Accident and Emergency residents
Bottom Line:
There is some evidence of the usefulness of telemedicine in wound assessment for hand injuries.
References:
- Hsieh, Ching-Hua. Tsai, Hui-Hong .Yin, Jer-Wen, et al. Teleconsultation with the mobile camera phone in digital soft tissue injury: a feasibility study.
- Pap, Stephen A. Lach, Elliot. Upton, Joseph. Telemedicine in plastic surgery: E-consult the attending surgeon.
- Scerri,G. and Vassallo, D.J.. Initial plastic surgery experience with the first telemedicine links for the British Forces.
- Buntic, R F. Siko, P P. Buncke, G M, et al.. Using the internet for rapid exchange of photographs and X ray images to evaluate potential extremity replantation candidates.