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

Vyas, Krishna S. MD, PhD, MHS*; Hambrick, H. Rhodes BS; Shakir, Afaaf BS; Morrison, Shane D. MD, MS§; Tran, Duy C. BS; Pearson, Keon BA; Vasconez, Henry C. MD; Mardini, Samir MD*; Gosman, Amanda A. MD#; Dobke, Marek MD, PhD#; Granick, Mark S. MD**

doi: 10.1097/SAP.0000000000001044
Review Article
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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.

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.

Received June 21, 2016, and accepted for publication, after revision January 2, 2017.

Conflicts of interest and sources of funding: Dr. Mark S. Granick is a speaker for Novadaq, moderated 1 conference concerning acellular dermal matrix; Board of Directors, Waterjel Inc. a producer of OTC burn products. The other authors have no financial interest to declare in relation to the content of this article. None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this manuscript. No funding was used in the preparation of this systematic review.

Reprints: Mark S. Granick, MD, 140 Bergen Street E1620, Newark, NJ 07103, USA, Division of Plastic Surgery, Department of Surgery, New Jersey Medical School-UMDNJ. E-mail: mgranickmd@njms.rutgers.edu.

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