Algorithm for Facial Reconstruction

Shared decision-making is the new standard clinical practice, however, in most fields of medicine we lack the tools to incorporate patients opinions. This is also true in the field of plastic surgery. The aim of our study is to develop and incorporate surgeons opinions AND patient opinions in facial reconstruction in an evidence-based manner. Our end goal is to develop a web-based platform from which surgeons and patients can benefit in facial reconstruction decision-making, also acting as a knowledge database. Also this questionnaire may partly replace routine outpatient visits during follow-up, hence making care more efficient. Moreover, by implementing the Face-Q, these measures will be used to compare different hospitals when it comes to patient satisfaction about different aspects of care.

In our clinic we perform approximately 500 facial reconstructions a year. These patients need reconstruction of facial defects. There is not a standard operating protocol for facial defects, right now the operating technique is dependent on the preference of the surgeon on the case. The first step in our study is to assess the patient satisfaction with the outcome of the surgery. Since this situation is not unique for our local clinic, we are collaborating with hospitals throughout the Netherlands  (Zorggroep Twente, Maastricht University Medical Centre, Leiden University Medical Center, Erasmus Medical Center, Maxima Medisch Centrum, st Anna Hospital have joined in our study so far) and abroad (Memorial sloan Kahterine, New York), aiming to collaborate with as many hospitals worldwide as possible.

To do so, all patients undergoing facial reconstruction surgery will be asked to fill out the ‘FACE-Q’ questionnaire; a newly developed psychometric validated patient reported outcome measure (PROM) that we have now translated and validated for the Dutch situation. In order to minimize patient burden it is of the utmost importance that the questionnaires are short, but still give insight in patient opinions. Collaboration with Harvard MEDICAL school has been set-up to implement a tool to create questionaires with the greatest efficacy.

For this first step we need 100 patients to complete the validation process, after which we plan to include another 1000 patients in 2 years. The goal, however, is to create a new standard method of working where patients are always asked for their opinion in a standardized way. After completing this first step, we will be able to incorporate patient satisfaction in the decision process.

For the second stage we will incorporate patients satisfaction scores with surgeons expertise based on literature in an algorithm. This algorithm will be developed with the goal to assist surgeons and patients with the decision making process for facial reconstruction surgery, by combining opinions and evidence from both groups. The tool thereby created will never be ‘finished’, since evidence and opinions will keep the algorithm and knowledge base updated, creating a self-learning cycle.