Dermatosurgery: total quality management in a dermatology department.

BACKGROUND: Dermatosurgery (DS) is a growing sector in dermatology. Performance measurement is organized worldwide to improve the quality of health care. Clinical audit relies on self-assessment, comparison with guidelines, frames of references and implementation of improvement actions. OBJECTIVE: To assess the efficiency of our DS department. METHODS: A clinical audit focusing on the organization of the DS unit, patient routing, continuing medical education and training for students was conducted by two external auditors. After an initial evaluation, improvements were implemented and reassessed 1 year later by the same auditors. RESULTS: The audit resulted in the implementation of preoperative consultation, improved pre- and postoperative information leaflets for patients, standardizing of surgery reports, earmarking of funds for materials, and patient satisfaction survey. The training of residents was organized. CONCLUSION: This audit was a driving force for communication among the medical and paramedical teams and helped improve patient care and training of residents in DS. It also highlighted areas needing further improvement.

[Revision of interlocking rod for loosening of THP. Concept--preliminary results]. / Tige de reprise verrouillée pour descellement de P.T.H. conception--résultats préliminaires.

This revision rod, used temporarily, is interlocked in the distal healthy part of the femur. It is indicated in the treatment of loosening, even with extensive destruction, whether this is done by filling the fragile part of the femur with bone chips and marrow or by reconstruction accomplished by gliding the femoral heads on the rod. The clinical results were observed for 21 replacements, performed between 1987 and 1990, for the following indications: 14 loosenings, of which 10 had major bone defects; 4 fractures, of which 3 received a prosthesis; 2 infected resection prostheses; and one broken porous metal Judet prosthesis. There was one failure due to flare-up of infection in a prosthesis that was initially infected. The complete treatment, with implantation of a standard prosthesis, was only performed in 5 cases. We left the revision rod in place in elderly patients, in major reconstructions, or when the patients refused a new operation. The anatomical results are encouraging. There was good assimilation of the bone grafts, confirmed by histology in cases of revision. There was no rupture or displacement of the material. The functional results were good with respect to pain and range of motion; they were less good with respect to stability, as could be expected in repeatedly operated patients.