Objectives: In this study we intend to focus on the human factor, the surgeon. Does the technique of each surgeon is a crucial factor in the postoperative bleeding sequels, and if it does what is the relative importance of the human factor.
Methods/Technique: Prospective consecutive series of 150 facelift patients operated by 3 surgeons with over 15 years of experience each included in the study group. Every surgeon operated on 50 consecutive patients. Non-of the surgeons were notified about the data collection before the end of study period, in order to eliminate patients selection and to minimalize bias of the results. All patients with diastolic BP over 90 mm Hg. receive Normopresan™ 0.15 mg P.O. with zip of water. Immediate after stabilization of total IV anesthesia the surgeons injects local anesthetics usually contain 1 gram of Lidocaine in 200 cc normal saline with 1:200,000 adrenaline. All surgeons do thick skin flap elevation (supra SMAS), and all treat the SMAS either by plication only, smasectomy, partial or complete elevation and fixation according to the surgeon decision and preference. All surgeons uses JP drain #10 and hugged dressing with mild to moderate pressure. Patient vital signs are being observed continuously for two hours in which systolic BP must be kept below 140 mm Hg. Following this period the patient is transfer to the ward instructed for minimal activity, minimal talking, soft and cold food and beverage, and notifying the nurse about any sudden pain immediately. Once the nurse suspect any form of hematoma she called the physician on-call and the surgeon. All patient medical data, ASA risk level and any case of bleeding or hematoma either treated bedside (minor type) or in the operating room (major type) were recorded only by the anesthesiology team. Once the study end all the data was given to the senior author.
Results/Complications: The patient age ranged between 46 - 78 with average 58 years old. Off them: six male and 144 female. The ASA diversion was 72 ASA I and 77 ASA II and one with ASA III. Surgeon A has 12 major and 4 minor post-operative hematoma; Surgeon B has 5 major and 5 minor post-operative hematoma; Surgeon C has one major and one minor post-operative hematoma.
Conclusion: The study results strongly support the crucial and unique impact of the surgeon technique finesse on the post-operative hematoma. Moreover, our study support that major post-operative hematoma over 2% of the patients is most probably surgeon technique related only. Detailed and franc knowledge exchange between experienced surgeons is the most important factor in reducing the complication rate in this operation.