Digital Photography in the Modern Plastic Surgery Practice

Abstract

Sir:FigureAlthough many specialties take advantage of visual documentation, no other field takes this more to heart than plastic surgery. Photography to plastic surgery is like radiography to orthopedic surgery. The average digital camera and memory card can store thousands of high-quality photographs. Retrieving these photographs in an efficient, expedited manner becomes important for cataloguing patients and cases for oral board examinations, documentation and improvement of patient outcomes, medicolegal aspects, and clinical research, to name a few. The litigious climate of modern medicine further necessitates meticulous, careful organization.1 A misfiled photograph is an image never taken. The senior author (M.A.L) developed and tailored a simple Dewey Decimal System–like classification system for photographs, the Lesavoy Enumeration System, over a period of 35 years designed to encompass the entire spectrum of his and most plastic surgery practices. Such a system has never been described, and would benefit all students, residents, and plastic surgeons alike. In a manner similar to the Dewey Decimal System, the current system assigns numbers from 1 to 163+. These numbers are split among three categories: general plastic surgery (1 to 87), hand surgery (87.5 to 140.7), and craniofacial surgery (141 to 163). Microsurgery and cosmetic surgery disciplines are included in the general plastic surgery category. Among the general categories, the individual sections are alphabetical. Multiple categories may be assigned to the same patient. For example, if a plastic surgeon wanted to classify a cosmetic patient who received fillers, abdominoplasty, and breast augmentation, the following classifications may be used: 1 (abdominoplasty), 11 (breast augmentation), and 16.45 (Restylane). If a file were to be renamed, according to a [date][patient name][(categories)(categories)].jpg type scheme, the file name would be “10.17.11_Miss Jones(1)(11)(16.45).jpg” (Fig. 1). The Lesavoy Enumeration System photograph classification may be downloaded at the http://www.drlesavoy.com.Fig. 1: Sample photograph. The series of photographs would be printed onto a proof sheet by office staff for the surgeon to review. The surgeon would then label a series of photographs according to their Lesavoy Enumeration System category. For example, these photographs were labeled with the patient's name, date, and the following Lesavoy Enumeration System categories: 8.5 (Mohs' excision), 60 (nasal reconstruction), and 35 (grafts).The power of the Lesavoy Enumeration System is the customizability: additional decimal points may be added if further subclassification is required. For example, suction lipectomy is 78.3. Further classification allows specification of regions: 78.301 for abdomen, 78.31 for arms, and 78.313 for breast. Frequently used coding numbers will become familiar, allowing for quick naming and searching with search functions discussed in the next section. Photographs are taken digitally, and a staff member downloads photographs from the memory card at intervals of the surgeon's desire. Before each clinical photograph, a picture is taken of the patient's name and date to identify subsequent clinical photographs. The photographs are then downloaded onto a proof sheet. Categories from the Lesavoy Enumeration System are then assigned to each group of photographs by the surgeon, and undesirable photographs are deleted. The staff member then takes the proof sheet and renames each photograph in the predetermined scheme and files are stored in triplicate by Lesavoy Enumeration System category, name of patient, and date (Fig. 2). Alternatively, the user can choose one method of storage that suits their need the most (e.g., storage by category) and use search features to search for dates and names. Each photograph is printed and placed in the clinical chart. This allows surgeons and patients to view photographs without cumbersome disks and computers in every examination room.Fig. 2: Basic workflow management. This scheme provides a simple method of renaming files by a preset scheme. Files are then copied in triplicate and placed in respective folders. LENS, Lesavoy Enumeration System.The Lesavoy Enumeration System is also an excellent tool for clinical research. Assistants can retrospectively retrieve photographs of a relevant category—for example, eyelid ptosis reconstruction, 27.6—and obtain all photographs of the surgeon's eyelid ptosis cases, names, and surgery date. The researcher can retrieve the clinical charts of patients and initiate a clinical chart review. The Lesavoy Enumeration System has stood the test of time, and has been given to almost every one of the senior author's students, residents, and colleagues, with excellent feedback. It is time and cost saving, and affords standardized photograph classification in the modern plastic surgeon's practice. Malcolm A. Lesavoy, M.D. Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at the UCLA, Los Angeles, Calif. Kenneth L. Fan, M.D. Department of Plastic Surgery, Georgetown University Hospital, Washington, D.C. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.