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Dermatology & PlasticSurgery Institute

2008Outcomes

2

Institute Overview

Dermatology & Plastic Surgery Institute 1

Surgical OverviewTo promote quality improvement, Cleveland Clinic has created a series of Outcomes books similar to this one for many of its institutes. Designed for a physician audience, the Outcomes books contain a summary of our surgical and medical trends and approaches, data on patient volume and outcomes, and a review of new technologies and innovations.

Although we are unable to report all outcomes for all treatments provided at Cleveland Clinic — omission of outcomes for a particular treatment does not mean we necessarily do not offer that treatment — our goal is to increase outcomes reporting each year. When outcomes for a specific treatment are unavailable, we often report process measures associated with improved outcomes. When process measures are unavailable, we may report volume measures; a volume/outcome relationship has been demonstrated for many treatments, particularly those involving surgical techniques.

In addition to our internal efforts to measure clinical quality, Cleveland Clinic supports transparent public reporting of healthcare quality data and participates in the following public reporting initiatives:

• Joint Commission Performance Measurement Initiative (www.qualitycheck.org)

• Centers for Medicare and Medicaid (CMS) Hospital Compare (www.hospitalcompare.hhs.gov)

• Leapfrog Group (www.leapfroggroup.org)

• Ohio Department of Health Service Reporting (www.odh.ohio.gov/healthStats/hlthserv/hospitaldata/hospperf.aspx)

Our commitment to providing accurate, timely information about patient care will also help patients and referring physicians make informed healthcare decisions. We hope you find these data valuable. To view all our Outcomes books, visit Cleveland Clinic’s Quality and Patient Safety website at clevelandclinic.org/quality/outcomes.

Outcomes 20082

Dear Colleague,

On behalf of Cleveland Clinic, I am pleased to present our 2008 Outcomes books. The primary purpose of our annual Outcomes book initiative is to promote quality improvement at Cleveland Clinic, thereby optimizing the care we provide to our patients. Measuring and reporting outcomes reflects our organizational commitment to accountability, transparency and results.

Each year, external stakeholders are requiring hospitals to report more and more quality and patient safety data. We view our Outcomes books as voluntary supplements to the required public reporting and an opportunity to share selected innovations with colleagues across the country.

Designed for the physician reader, each book in the annual series focuses on care provided by one of our patient-centered clinical institutes. We hope you find the content informative.

Sincerely,

Delos M. Cosgrove, MD CEO and President


what’s insideChairman’s Letter 04

Institute Overview 05

Quality and Outcomes Measures

Topical Immunotherapy for Severe Alopecia Areata 14

Psoriasis Treatment 17

Treatments in Dermatology for CutaneousT-cell Lymphoma 18

Surgical Treatment for Dermatofibrosarcoma Protuberans 19

Facelift Surgery in the Elderly 21

Reconstructive Surgery 26

Surgical Treatment for Peripheral Neuropathy 32

Patient Experience 36

Innovations 38

Selected Publications 44

Staff Listing 50

Contact Information 54

Institute Locations 55

Cleveland Clinic Overview 56

Resources for Physicians 57

Chairman’s Letter

4

I am pleased to present our 2008 Outcomes, a condensed review of our medical and surgical results, trends and approaches in the Dermatology and Plastic Surgery Institute. Our physicians and staff are dedicated to continuous improvement in both the quality of our medical, surgical and aesthetic services, and the experience of our patients.

Among the institute’s major advancements this year was our successful completion of the first near-total face transplant in the United States. You’ll find an overview of this exciting innovation on the following pages. We also have advanced the treatment of psoriasis, improved the quality and safety in our Mohs surgery frozen section lab, and added CT scanning to improve revascularization during DIEP breast reconstruction procedures.

We continue to refine our techniques and improve our treatment of dermatologic conditions, as well as our aesthetic and reconstructive procedures to bring state-of-the-art care to our patients. We hope that the information in this Outcomes book will serve as a valuable tool and reinforce your confidence in the quality of care our institute offers. We consider you a partner in the care of your patients and will continue to improve our communications with you regarding your patient’s diagnosis, treatment options and outcomes. Please contact us about your experiences and let us know how we can better serve you.

Frank A. Papay, MD, FACSChairman, Cleveland Clinic Dermatology and Plastic Surgery Institute

Dermatology & Plastic Surgery Institute

Institute Overview

The first year anniversary of the Dermatology & Plastic Surgery Institute has witnessed medical breakthroughs in clinical research and healthcare management. By combining the departments of Dermatology and Plastic Surgery, we have increased the networking among specialties to produce advanced state-of-the-art care and aesthetic services for patients with complex dermatological and plastic surgery reconstructive needs. In addition, it has allowed us to enhance our residency and fellowship programs, building leadership in both medical fields. The institute also defines new interdisciplinary approaches to education, research and patient care.

Cleveland Clinic’s Dermatology & Plastic Surgery Institute offers services in several specialty areas including:

• clinical and cosmetic dermatology

• dermatopathology

• dermatologic surgery

• cutaneous oncology

• Mohs micrographic surgery and reconstruction

• pediatric dermatology

• industrial and environmental dermatology

• facial cosmetic surgery

• cosmetic breast surgery and breast reconstruction

• body contouring including liposuction

• plastic surgery after massive weight loss

• pediatric plastic surgery including craniofacial surgery

• hand surgery

• microsurgery

• complex wound repair

• reconstruction after cancer.

5

The institute’s dermatologists and plastic surgeons are located at 11 sites throughout northeast Ohio including our main campus, Lutheran Hospital and family health centers in Beachwood, Chagrin Falls, Independence, Lorain, Strongsville, Solon, Westlake, Willoughby Hills, and Wooster.

Our Department of Dermatology provides world-renowned expertise in the diagnosis and management of a full spectrum of dermatologic conditions. One of the fastest growing services, Mohs micrographic surgery, provides the highest cure rate for high-grade, non-melanoma skin cancers while sparing the normal tissue and skin. In 2008, Cleveland Clinic dermatologists performed over 2,500 Mohs procedures. We now offer Mohs surgery at our family health centers in Independence and Beachwood, along with main campus. In addition, we improved patient access in 2008, for those patients with complex dermatologic problems. The availability of reconstruction by plastic surgery for particularly large or complex Mohs surgical defects optimizes cosmetic outcome and function. The Dermatology Department continues to meet community responsibilities by participating throughout the region in skin cancer screening days, activities related to National Skin Cancer Week, and other community events. Both departments participate in health talks and educational forums for patients, potential patients, and families.

During 2008, the institute focused on minimally invasive techniques in facial cosmetic surgery. This includes using alternatives to face and neck lift surgery, short-scar facelifts, and minimally invasive facelift techniques. The addition of other light-based modalities, including laser, continued to advance our nonsurgical efforts in facial rejuvenation. In 2009, the institute plans to adopt other modalities that tie into antiaging with the advent of Lifestyle 180 in the Wellness Institute.

Outcomes 2008

Institute Overview

Dermatology Volumes

Ultraviolet light treatments have more than doubled since 2004.

Surgeries

The total number of Mohs micrographic surgeries has steadily increased.

Phototherapy Treatments

2004 2005 2006 2007 2008

3,000

2,000

1,000

0

Number

2004 2005 2006 2007 2008

8,000

6,000

4,000

2,000

0

Number

6


Laser Treatments

Ultraviolet light treatments have more than doubled since 2004.

Treatments

Treatments

The total number of Mohs micrographic surgeries has steadily increased.

Botox - Cosmetic

2004 2005 2006 2007 2008

10,000

8,000

6,000

4,000

2,000

0

Number

2005 2006 2007 2008

10,000

8,000

6,000

4,000

2,000

0

Number

Total VisitsFemaleMale

7

8

Institute Overview

Treatments

Treatments

Institute Combined Laser Hair Removal

Botox - Cosmetic

Plastic Surgery Volumes

2006 2007 2008

800

600

400

200

0

Number

Dermatology Plastic Surgery

20062005 2007 2008

300

200

100

0

Number

FemaleMale

Total Visits

Outcomes 2008

9

Surgeries

Surgeries

Facial Cosmetic Surgeries

Primary and Secondary Rhinoplasties

2004

180

120

60

0

Number

BrowliftBlepharoplasty

Facelift/Neck

2005 2006 2007 2008

2004

100

80

60

40

20

0

Number

PrimarySecondary

2005 2006 2007 2008


Outcomes 2008

Institute Overview

Surgeries

Surgeries

Cosmetic Breast Surgery

Body Contouring

2004

250

200

150

100

50

0

Number

Breast AugmentationMastopexy

Breast Reduction

2005 2006 2007 2008

2004

160

120

80

40

0

Number

Lipo Trunk/ExtremitiesLipo Head/Neck

Abdominoplasty

2005 2006 2007 2008

10


Surgeries Surgeries

SurgeriesSurgeries

Cosmetic Breast Surgery Breast Reconstruction

Body ContouringDIEP Flap Reconstruction (Microsurgery)

2004

Number

Recon w/ProsthesisRecon w/Latisimus Dorsi FlapOncoplasty

Recon TRAM

2005 2006 2007 2008

400

300

200

100

0

Number

2005 2006 2007 2008

100

75

50

25

0

11

Outcomes 200812

Institute Overview

Surgeries

Surgeries

DIEP Breast Reconstruction (N = 86)

2008

Endoscopic and Open Carpal Tunnel Surgery

Number

Success Failure

100

75

50

25

0

2004

250

200

150

100

50

0

Number

Endoscopic Open

2005 2006 2007 2008

Surgeries

Surgeries

DIEP Breast Reconstruction (N = 86)

2008

Endoscopic and Open Carpal Tunnel Surgery

13

14

Surgical Overview

Alopecia areata (AA) is a life-altering condition manifested by hair loss. Our dermatologists specializing in this relatively common disease describe this condition using “Bergfeld’s Clinical Classification:”

Type I Mild patchy < 25% of scalp

Type II Moderate patchy ≤ 25 to < 50%

Type III Severe patchy ≥ 50% to < 75%

Type IV Extensive patchy ≥ 75% to < 100%

Type V Diffuse form of AA

Type VI Alopecia totalis 100% of scalp

Type VII Alopecia universalis

The cause is unknown, but hypothesized to be an autoimmune condition. The most effective mode of therapy for Type III is a contact sensitizer, Diphenylcyclopropenone (DPCP). When rubbed onto human skin it produces an allergic contact dermatitis after about 14 days. The hair regrowth is due to the production of T suppressor cells in the treated area which inhibits the autoimmune reaction to the hair-specific antigen. The concentration of DPCP and amount of application depends on the extent of the hair loss, but the usual concentrations are between .001 percent and 2 percent.

Other additional therapies used in conjuction with DPCP include:

• Intralesional corticosteroid (Triamcinolone) injections on the scalp or eyebrow. New hair growth appears within four weeks, and this treatment is repeated every four to six weeks as necessary.

• Anthralin cream 0.5 percent to 1 percent (Dritho-Scalp).

• Minoxidil, over-the-counter topical twice daily.

Topical Immunotherapy for Severe Alopecia Areata

14 Outcomes 2008


Before and after treatment with DPCP 0.3% or 0.4% to eyebrows twice/week and intralesional 2.5mg trimacinolone injections every four to six weeks for five treatments.

Before and after treatment with anthralin (Dritho-Scalp) 0.5% & minoxidil 2% twice daily to scalp.

Before | January 4, 2008

Before | January 4, 2008

After | June 6, 2008

After | June 6, 2008

Outcomes 200816

Before and after treatment with .06% DPCP twice per week to scalp, and intralesional triamcinolone 5 mg/ml every six weeks.

September 12, 2007 May 30, 2008 October 30, 2008

Topical Immunotherapy for Severe Alopecia Areata


Use of Anti-TNF Agents to Treat Moderate to Severe Psoriasis at Cleveland Clinic

Psoriasis is an inflammatory dermatosis that affects approximately two percent of the population. The disease severity can range from occasional plaques that resolve with topical medications to erythroderma covering 100 percent of the body surface area. Moderate to severe psoriasis can cause significant disability and poorer quality of life. In recent years, several studies have found an increased link between psoriasis and metabolic syndrome, as well as increased markers of systemic inflammation, suggesting that psoriasis itself may confer an increased risk of mortality.

Traditionally, the treatments available to psoriasis patients include topicals, UV light therapy, and systemic medications. Topical and UV treatments are relatively low risk and well tolerated, but are not always effective for patients with more severe disease. Systemic medications, including acitretin, methotrexate, and cyclosporine, may be effective for severe disease but carry a harsh side effect profile.

Given the systemic inflammation present in psoriasis patients, it is not surprising that biologic agents, specifically ones that block TNF-α, have been found to be effective in treating moderate to severe psoriasis. Currently, three anti-TNF medications have been FDA approved for treatment of psoriasis.

Results:

Since 2001, Cleveland Clinic has treated psoriasis patients who are recalcitrant to traditional medications with anti-TNF agents. In a chart review of psoriasis patients seen in our dermatology clinic who were treated with anti-TNF agent for a minimum of six months, we found that 93.8 percent showed improvement (n=97).

Large plaque psoriasis on trunk.

Status: post 12 weeks; 50 mg etanercept once weekly. Clearing psoriasis, residual post-inflammatory hyperpigmentation.

Psoriasis Treatment

18 Outcomes 2008

Tumor stage CTCL patient Post treatment with bexarotene capsules and radiation therapy

Treatments in Dermatology for Cutaneous T-cell Lymphoma

Cutaneous T-cell Lymphoma (CTCL) is a rare type of non-Hodgkin’s lymphoma. It manifests in the skin, blood, lymph nodes, and other internal organs. CTCL presents in the skin as patches, plaques, tumors, and erythroderma. As a rare disease, only about 1,900 new cases are diagnosed yearly in the United States. Staging of disease (I to IV) at the time of diagnosis is a predictor of survival. Decreased survival correlates with increased tumor burden.

Cleveland Clinic patients may receive multiple modality therapy, which includes ultraviolet radiation (narrow band ultraviolet B, ultraviolet A, psoralen plus ultraviolet A), electron beam radiation, topical and systemic bexarotene, vorinostat, extracorporeal photopheresis, and/or various systemic chemotherapies.

Of the early staged IA to IIA CTCL patients at Cleveland Clinic treated with bexarotene capsules, 59 percent had improvement of either a complete or partial response.

19Dermatology & Plastic Surgery Institute

Annual Number of DFSP Patients Treated with Mohs Micrographic Surgery (N=44)

Surgical Treatment for Dermatofibrosarcoma Protuberans

Dermatofibrosarcoma protuberans (DFSP) is an uncommon cutaneous malignant neoplasm that is locally aggressive, slow growing, demonstrates an infiltrating growth pattern, and has a relatively high rate of recurrence. DFSP most commonly occurs on the trunk and proximal extremities, in the third and fourth decade of life. However, it can occur in infants and children. Most recurrences occur within three years of excision.

Surgical wide excision has been the treatment of choice for this tumor. Despite this treatment, a recurrence rate using undefined surgical margins is 49 percent to 53 percent. A wide excision, using defined surgical margins of 3 centimeters or more, down to and including the fascia, drops the recurrence rate to 11 percent to 20 percent.

Mohs micrographic surgery is the treatment of choice for DFSP and is usually performed under local anesthesia. This microscopically controlled surgery involves the removal of the involved cutaneous and subcutaneous tissue, detailed mapping, and horizontal frozen section histology in order to examine the entire surgical margins. If the margins are positive, the Mohs

2001 2002 2003 2004 2005

Year

2006 2007 2008

Patients

0

12

10

8

6

4

2

20

Surgical Treatment for Dermatofibrosarcoma Protuberans

surgeon repeats this procedure by serial excisions at only the specific sites of residual tumor, until no tumor is found. If this tissue is clear of tumor as determined by the Mohs surgeon in his or her role as pathologist, the Mohs surgeon then repairs the surgical wound. For very large tumors or for pediatric patients, the Mohs surgeon collaborates with the plastic surgeon, who performs the reconstruction under general anesthesia. This procedure results in tissue conservation and a superior cure rate for DFSP. In the medical literature, recurrence rate after Mohs micrographic surgery is zero to six percent.

Forty-four patients with DFSP were treated at Cleveland Clinic with Mohs micrographic surgery from 2001 through 2008.

Based on the potential for recurrence within the standard period of three years, the recurrence rate was calculated for 24 of the 27 patients (three were unavailable for follow up) treated with Mohs micrographic surgery from 2001 to 2005. The resulting recurrence rate at three to seven years was only four percent.

21

Facelift Surgery in the Elderly (N=68)

2005 – 2008

Facelift Surgery in the ElderlySurgical Treatment for Dermatofibrosarcoma Protuberans

The mean age of our elderly population undergoing facelift surgery was 70 with the eldest being 89. A total of 68 elderly patients was included in this data. Of those, 61 patients (89.7 percent) had a necklift performed in addition to their facelift procedure, and 24 patients (35.3 percent) underwent additional cosmetic procedures such as browlift and/or blepharoplasty at the time of their facelift surgery.

Facelift Only Facelift &Necklift

Face, Neck,Browlift and/orBlepharoplasty

Cases

0

80

60

40

20

Outcomes 2008

Facelift Surgery in the Elderly

Major complications included two facial hematomas and two incidences of facial/auricular nerve weakness. None of these patients had long-term sequelae related to their complications.

This data confirms that chronologic age is a poor predictor of adverse outcomes when evaluating the risk of elderly people undergoing facelift surgery. In the absence of any significant systemic disease, facelift surgery can be safely performed in the elderly population.

22

Systemic Major Minor

Percent

16

12

8

4

0

Complications reported following facelift surgery (N = 68)

2005 – 2008

23

front view

front view

profile view

profile view

Preoperative

Postoperative 5 years

60-year-old female


Outcomes 2008

Facelift Surgery in the Elderly

front view

front view

profile view

profile view

Preoperative

Postoperative 7 months

63-year-old female

24

25

front view

front view

profile view

profile view

Preoperative

Postoperative 1 year

64-year-old female


26

Reconstructive Surgery

DIEP Breast Reconstruction with CT Angiogram

Breast cancer patients who need mastectomy now have three reconstruction options:

• implant placement;

• transverse rectus abdominus myocutaneous (TRAM) flap which makes use of the patient’s own tissue and requires the use of the rectus abdominis muscle with incorporation of overlaping fat tissue;

• deep inferior epigastric perforator (DIEP) free-flap reconstruction.

The DIEP reconstruction is dedicated to the preservation of the rectus abdominis muscle and its function. Other advantages to this procedure are the minimal donor site morbidity and the experience of less discomfort by the patient when compared with the TRAM flap procedure.

From August 2007 to September 2008, Cleveland Clinic’s plastic and reconstructive surgery team implemented the abdominal wall CT angiogram (CTA) as a novel and accurate

tool to improve presurgical planning. This has resulted in a decrease of the surgical time and of the morbidity for this patient population.

The purpose of the CT angiogram is to accurately predict the perforators’ location and character. In this study, the CTA was performed one to three weeks preoperatively on 67 patients, who were scheduled for DIEP reconstruction following mastectomy. Nonionic contrast was used to scan the area from the ischial tuberosity to mid-liver. The bilateral dominant perforators were located and the subfascial and intramuscular course was then determined. Intraoperatively, a doppler was used based on the CTA findings to correlate dissection anatomy with the CTA. There is a relationship between the number of perforators used to perfuse the flap and morbidity. The more perforators used, the more dissection, which leads to a higher morbidity. Therefore, ideally, we want to keep the flap with minimal disruption to the muscle by taking only the necessary perforators.

In 95.7 percent of the cases, the CTA accurately predicted the perforator location within 8 mm. These surgeries resulted in only one flap failure and two reoperations; one for venous congestion due to mal-positioning of the drain and another due to hematoma. In conclusion, the CT angiogram provides accurate information about the course of the DIEP, as well the location and numbers of perforators. It is the road map; near infrared spectroscopy (NIRS) supplements the information provided by CTA and allows us to predict which perforators contribute substantially to the perfusion of the flap. It helps us to decide which perforators, and how many perforators, are needed for adequate perfusion of the flap. In short, NIRS allows us to validate our flap design intraoperatively. This may allow us to design and harvest our flaps more precisely, and may ultimately lead to flaps that are more reliable with potentially less risk of fat necrosis.

Outcomes 2008

27

Preoperative profile view

Preoperative frontal view


Right DIEP and matching left mastopexy

Right DIEP and left matching mastopexy

Results following DIEP, demonstrating abdominal

donor preservation as well as aesthetically reconstructed breast.

6 months postoperative profile view

6 months postoperative frontal view



Outcomes 200828


Patient Satisfaction with Nipple Preservation

From 2001 to 2008, Cleveland Clinic breast surgeons performed 141 nipple sparing mastectomies (NSM) with immediate breast reconstruction by the plastic and reconstructive surgery team. Of the 141 patients asked to rate their satisfaction with various aspects of the nipple areolar complex (NAC) following this NSM and reconstruction, 78 patients responded.

Patient Satisfaction with NAC following NSM (N = 78)

2001 – 2008

80

0Appearance Symmetry Color Position

Patient Survey Items

Sensation Arousal Texture

60

20

40

Percent Repondents

PoorFairGoodExcellent

29

Aspects of the Nipple Areolar Complex Patients Would Change if possible (N = 78)

2001 – 2008

Retrospective Procedure Choice (N = 78)

2001 – 2008


0Appearance Symmetry Color Position


Sensation Arousal Texture

60

20

40

Percent Repondents

Definitely No Maybe


Definitely Yes

Percent Respondents

0

80

60

40

20

Outcomes 2008


Within the last decade, newer mastectomy techniques have continued to improve. Nipple sparing mastectomy (NSM) can be performed safely in the appropriately selected patient and has become an accepted technique in the treatment of carefully selected early stage breast cancers. Historically, the nipple areolar complex (NAC) was removed to maximize oncologic safety. More recent reports in the literature have shown that preservation of the NAC is oncologically safe.

Nipple reconstruction may positively influence many aspects of patient satisfaction and can yield good aesthetic results, although these results are not always ideal. Patients have expressed dissatisfaction with various aspects of their reconstructed NAC, including lack of projection, poor color match, shape, size, texture and position. These problems, as well as the associated cost and risk of additional nipple reconstruction procedures, could be obviated by preserving the native NAC at the time of mastectomy.

30


Prior to her diagnosis with right breast cancer this patient had previous breast augmentation. The patient was then treated

with right nipple sparing mastectomy and reconstruction

with cohesive silicone gel. Postoperative views are one year

following surgery.

Bilateral prophylactic nipple-sparing mastectomy and bilateral

DIEP reconstruction


Preoperative view


1 year postoperative view

Outcomes 200832

Surgical decompression of peripheral nerves is performed in Plastic Surgery on patients with lower and upper extremity peripheral neuropathy. In 2008, 74 patients suffering from diabetic and nondiabetic neuropathy with evidence of underlying nerve compression were treated using this procedure.

Treated nerves included the common peroneal nerves (CPN), deep peroneal nerves (DPN), superficial peroneal nerves (SPN) and posterior tibial nerves (PTN) in the lower extremity, and the ulnar and median nerves in the upper extremity. Clinical evaluation and preoperative Quantitative Sensory Testing were used to identify patients who would benefit from surgery.

The nondiabetic group included mostly patients with lower extremity neuropathy of undetermined etiology and those following injury.

Surgical Treatment for Peripheral Neuropathy

Diabetics and Non Diabetics Undergoing Nerve Decompression (N = 74)

2008

24% Non Diabetics24% Non Diabetics

76% Diabetics76% Diabetics

100%100%


Diabetics and Non Diabetics Undergoing Nerve Decompression (N = 268)

2008

CPN DPN SPN PTN

Nerves

Ulnar Median

80

60

40

20

0

Number

Outcomes 2008

Surgical Treatment for Peripheral Neuropathy

Improvement of Muscle Strength Following Surgical Decompression of the CPN (N = 73)

2008

Clinical Outcome (N = 74)

2008

Month 1 Month 2

5

4

3

2

1

0

Muscle power

EDLEHB

30% Good30% Good

16% Fair16% Fair

54% Excellent54% Excellent

100%100%

Improvement was achieved in the muscle power of the extensor hallucis longus (EHL) and extensor hallucis brevis (EHB) after surgical decompression of the common peroneal nerve at the neck of the fibula.

The clinical outcome was measured over a mean duration of 8.1 months. Clinical outcome was classified according to the level of postoperative pain, use of neuropathic and narcotic pain medications, return of sensation, improvement in walking distance and return to work.

34

Outcomes 200836

Patient Experience

Cleveland Clinic has placed a renewed emphasis on improving the patient experience by establishing the role of Chief Experience Officer. Recognizing that patients seek more than solely a successful clinical outcome, the mission of the Office of Patient Experience is to create an environment that enhances the well-being of our patients, families and employees in a way that elevates Cleveland Clinic’s reputation as one of the world’s best hospitals.

In 2008, the Office of Patient Experience dedicated teams within the institutes to research and implement innovative patient- and family-based programs that support this mission.

Outpatient – Dermatology & Plastic Surgery Institute

100

80

0

60

40

20

Percent

Excellent Very Good Good Fair Poor

Source: Quality Data Management, a national hospital survey vendor

2008 (N = 1,803)2007 (N = 1,620)

Overall Rating of Outpatient Care and Services

2007 – 2008


Recommend Outpatient Provider

2007 – 2008

100

80

0

60

40

20

Percent

Excellent Very Good Good Fair Poor


2008 (N = 1,803)2007 (N = 1,620)

100

80

0

60

40

20

Percent

ExtremelyLikely


Very Likely SomewhatLikely

SomewhatUnlikely

VeryUnlikely

2008 (N = 1,803)2007 (N = 1,620)

Rating of Outpatient Provider

2007 – 2008

Outcomes 2008

Innovations

Quality and Safety InnovationDermatology Mohs Micrographic Surgery Lab

This frozen section laboratory is an integral part of the Mohs micrographic surgical procedure. To achieve optimal surgical results for our patients and to ensure overall excellence in our practice, the laboratory must function in a highly efficient and effective manner while adhering to institutional and external quality standards. We have a quality management program in place to ensure our high standards.

In order to provide a safer environment for employees, especially those who are or may become pregnant, a decision was made by the Quality Officer of the lab to remove two toxic chemicals, Xylene® (the most commonly used clearing agent in laboratories) and Formalin® (a fixative) from the staining protocol. The replacement reagents Rapid Fixx®, fixative, and ClearSolv®, clearing agent, were placed in the staining lineup.

This decision presented a great challenge to the Mohs lab technician. Although this change eliminated toxic chemicals and created a safer environment, it did not achieve the same color, intensity, or quality of stain on the frozen section slides.

The Mohs lab technician met this challenge. After several attempts combining the nontoxic reagents, alcohols, and tap water, a new protocol was established that actually improved the color, intensity and quality of the stain. The quality of the stain surpassed any that had been achieved before.

Since this new protocol has been in place, pathologists, representing the College of American Pathologists and the Mohs College, visited our laboratory for accreditation purposes, and stated that our slides were the best they had ever seen.

38


In order to demonstrate the improved quality of the slides, two tissue samples from two different and random patients were selected. We then processed the first of these tissue samples from Case #1 patient and Case #2 patient with the old lineup using Xylene and Formalin. We then processed the second tissue samples from Case #1 patient and Case #2 patient with the new lineup using the nontoxic chemicals, Rapid Fixx and ClearSolv. We photographed the results through the microscope and the improvements are shown below:

Case # 1 with toxic chemicals in process

Case # 2 with toxic chemicals in process

Case # 1 with non toxic chemicals in process

Case # 2 with non toxic chemicals in process

Outcomes 2008

Innovations

40


“FIRST U.S. FACE TRANSPLANT DESCRIBED”Excerpt from The New York Times, 12/17/2008. The New York Times All right reserved. Used by permission and protected by the Copyright Laws of the United States. The printing, copying, redistribution, or retransmission of the Material without express written permission is prohibited.

In a 23-hour operation, transplant surgeons have given nearly an entire new face to a woman with facial damage so severe that she could not eat on her own or breathe without a hole in her windpipe, doctors at the Cleveland Clinic said here on Wednesday.

The highly experimental procedure, performed within the last two weeks, was the world’s fourth partial face transplant, the country’s first, and the most extensive and complicated such operation to date. Dr. Maria Siemionow led the surgical team, which took turns at the operating table so the doctors could rest, sleep and share expertise.

The woman is eventually expected to eat, speak and breathe normally and even smell again, her doctors said at a news conference. Feeling should return to her face in six months, and most facial functions in about a year, leading to her ability to smile after physical therapy to help train the muscles for that function.

Surgeons have performed multiple reconstructive procedures over the several years that the woman has been under their care, the doctors said, adding that they were left with no conventional treatment options to restore her facial function.

The operation was fiendishly complex, the doctors said. They had to integrate functional components like a nose and lower eyelids, as well as different tissue types, including skin, muscles, bony structures, arteries, veins and nerves. About 77 square inches of tissue were transplanted from the donor.

This is not cosmetic surgery in any conventional sense,” said Dr. Eric Kodish, chairman of the clinic’s bioethics department, who was part of the team that interviewed and evaluated the patient’s understanding of the risks in the experimental procedure.

“Not to downplay the difficulties of having a facial disfigurement, but one can live a long life and be disfigured,” said Stuart G. Finder, director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles.

But the benefits of a face transplant are not only cosmetic, Dr. Finder said, adding, “The repair of the face can also have significant social consequences — like the ability to speak, or the ability to eat, that can be replaced because of having lips.”

The transplant procedure began at 5:30 p.m. on an unspecified recent day as doctors tried to determine that the arteries and veins in the recipient’s neck, scarred from trauma and earlier surgery, could receive the transplant.

At 8 p.m., surgeons began recovering the donor’s facial tissues, carefully dissecting the arteries, nerves, soft tissue and bones to ensure a good blood supply. That effort took 9 hours, 10 minutes.

Meanwhile, surgeons removed scar tissues from the woman to make room for the facial graft.

At 5:10 the next morning, the surgeons began connecting the patient’s blood vessels to the donor graft vessels. When the graft turned pink and showed no signs of an immediate rejection, they went on to attach the facial graft to the woman’s face. They used microscopes to stitch arteries, veins and nerves from the donor graft to the woman’s head. Her ears and scalp are her own.

By 4:30 p.m., the woman had a new face.

41

Innovations

42 Outcomes 2008


Tolera Therapeutics Inc.

Maria Siemionow, MD, PhD, DSc, Chief Medical Director

This Cleveland Clinic spin-off organization, based on research studies from clinical protocols, was created to achieve a minimal immunosuppressive protocol for kidney transplant patients by the end of 2009.

The goal is to develop TOL-101 antibody as an induction therapy tested first on a solid organ - for use in kidney transplantation and applied to composite tissue allograft transplants such as face and hand transplants within the next 18 months.

Outcomes 2008

Selected Publications

44

The Dermatology and

Plastic Surgery Institute

staff authored more than

70 publications in 2008.

Akilov OE, Kosaka S, Maytin EV, Hasan T. Prospects for the use of differentiation-modulating agents as adjuvant of photodynamic therapy for proliferative dermatoses. J Dermatol. 2008 Apr;35(4):197-205.

Amado A, Taylor JS. Contact allergy to epoxy resins. Contact Dermatitis. 2008 Mar;58(3):186-187.

Amado A, Taylor JS. Contact dermatitis in the bowling pro shop. Dermatitis. 2008 Nov;19(6):334-338.

Amado A, Taylor JS, Murray DA, Reynolds JS. Contact dermatitis to pentylene glycol in a prescription cream for atopic dermatitis: case report. Arch Dermatol. 2008 Jun;144(6):810-812.

Amado A, McDonnell JK, Somani N, Bunting ST, Winfield HL. Cutaneous gamma-delta T-cell lymphoma. Leuk Lymphoma. 2008 Oct;49(10):2003-2005.

Churgin S, Isakov R, Yetman R. Reconstruction options following breast conservation therapy. Cleve Clin J Med. 2008 Mar;75 Suppl 1:S24-S29.

Cibull TL, Gleason BC, O’Malley DP, Billings SD, Wiersema P, Hiatt KM. Malignant cutaneous glomus tumor presenting as a rapidly growing leg mass in a pregnant woman. J Cutan Pathol. 2008 Aug;35(8):765-769.

Crowe JP, Patrick RJ, Yetman RJ, Djohan R. Nipple-sparing mastectomy update: one hundred forty-nine procedures and clinical outcomes. Arch Surg. 2008 Nov;143(11): 1106-1110.

D’Hue Z, Perkins SM, Billings SD. GMS is superior to PAS for diagnosis of onychomycosis. J Cutan Pathol. 2008 Aug;35(8):745-747.

de Medeiros LM, Fransway AF, Taylor JS, Wyman M, Janes J, Fowler JF Jr, Rietschel RL. Complementary and alternative remedies: an additional source of potential systemic nickel exposure. Contact Dermatitis. 2008 Feb;58(2):97-100.


Djohan R, Zins JE, Rolston DK, Hermann R. Breast Cancer Surgery and Breast Reconstruction: What the Options Are, What Your Patients Need to Know. Cleveland, OH: Cleveland Clinic Foundation; 2008. Cleve Clin J Med. v.75 Suppl 1.

Djohan R, Gage E, Bernard S. Breast reconstruction options following mastectomy. Cleve Clin J Med. 2008 Mar;75 Suppl 1:S17-S23.

Galiczynski EM Jr, Elston DM. What’s eating you? Pubic lice (Pthirus pubis). Cutis. 2008 Feb;81(2):109-114.

Grazul-Bilska AT, Banerjee J, Yazici I, Borowczyk E, Bilski JJ, Sharma RK, Siemionov M, Falcone T. Morphology and function of cryopreserved whole ovine ovaries after heterotopic autotransplantation. Reprod Biol Endocrinol. 2008 Apr 11;6:16.

Han L, Somani AK, Huang Q, Fang X, Jin Y, Xiang LH, Zheng ZZ. Evaluation of 308-nm monochromatic excimer light in the treatment of psoriasis vulgaris and palmoplantar psoriasis. Photodermatol Photoimmunol Photomed. 2008 Oct;24(5):231-236.

Hanaoka BY, Libecco J, Rensel M, Hajj-Ali RA. Peripheral mononeuropathy with etanercept use: case report. J Rheumatol. 2008 Jan;35(1):182.

Honari G, Ellis SG, Wilkoff BL, Aronica MA, Svensson LG, Taylor JS. Hypersensitivity reactions associated with endovascular devices. Contact Dermatitis. 2008 Jul;59(1):7-22.

Jankowska AM, Gondek LP, Szpurka H, Nearman ZP, Tiu RV, Maciejewski JP. Base excision repair dysfunction in a subgroup of patients with myelodysplastic syndrome. Leukemia. 2008 Mar;22(3):551-558.

Jokela TA, Lindgren A, Rilla K, Maytin E, Hascall VC, Tammi RH, Tammi MI. Induction of hyaluronan cables and monocyte adherence in epidermal keratinocytes. Connect Tissue Res. 2008;49(3):115-119.

Kaplan JL, Rotemberg S, Yetman R, Boggs O, Bena JF, Tang AS, Meisler E. Breast reduction: does the tumescent technique affect reimbursement? Plast Reconstr Surg. 2008 Sep;122(3):693-700.

Khariwala SS, Dan O, Lorenz RR, Klimczak A, Siemionow M, Strome M. Donor bone marrow in laryngeal transplantation: results of a rat study. Am J Otolaryngol. 2008 Jul;29(4):242-249.

Lubiatowski P, Unsal FM, Nair D, Ozer K, Siemionow M. The epineural sleeve technique for nerve graft reconstruction enhances nerve recovery. Microsurgery. 2008;28(3): 160-167.

Morrison CM, Shoda P, Zins JE. A simple method of maintaining patient modesty and standardisation in plastic surgery photography. J Plast Reconstr Aesthet Surg. 2008 Jun;61(6):716.

Morrison CM, Rotemberg SC, Moreira-Gonzalez A, Zins JE. A survey of cosmetic surgery training in plastic surgery programs in the United States. Plast Reconstr Surg. 2008 Nov;122(5):1570-1578.

Narra K, Diaz LM, Papay FA. A new approach to nipple reconstruction: the modified S-flap. Plast Reconstr Surg. 2008 Aug;122(2):89e-90e.

Nasir S, Zins JE. Giant eccrine adenocarcinoma of the scalp with intracranial invasion: resection and reconstruction using a vacuum-assisted closure device: technical case report. Neurosurgery. 2008 Aug;63(2):E376.

Outcomes 200846


Nasir S, Krokowicz L, Bozkurt M, Siemionow M. Inlay technique for large skin graft replacement in the small animal. Plast Reconstr Surg. 2008 Nov;122(5): 167e-168e.

Nasir S, Bozkurt M, Klimczak A, Siemionow M. Large antigenic skin load in total abdominal wall transplants permits chimerism induction. Ann Plast Surg. 2008 Nov;61(5):572-579.

Nasir S, Aydin MA. Wide combined thin free SCIA/SIEA flap. Ann Plast Surg. 2008 Dec;61(6):627-631.

Neubert JK, Mannes AJ, Karai LJ, Jenkins AC, Zawatski L, Abu-Asab M, Iadarola MJ. Perineural resiniferatoxin selectively inhibits inflammatory hyperalgesia. Mol Pain. 2008;4:3.

Olsen EA, Callender V, Sperling L, McMichael A, Anstrom KJ, Bergfeld W, Durden F, Roberts J, Shapiro J, Whiting DA. Central scalp alopecia photographic scale in African American women. Dermatol Ther. 2008 Jul;21(4): 264-267.

Ozmen S, Ayhan S, Demir Y, Siemionow M, Atabay K. Impact of gradual blood flow increase on ischaemia-reperfusion injury in the rat cremaster microcirculation model. J Plast Reconstr Aesthet Surg. 2008 Aug;61(8):939-948.

Pariser D, Loss R, Jarratt M, Abramovits W, Spencer J, Geronemus R, Bailin P, Bruce S. Topical methyl-aminolevulinate photodynamic therapy using red light-emitting diode light for treatment of multiple actinic keratoses: A randomized, double-blind, placebo-controlled study. J Am Acad Dermatol. 2008 Oct;59(4):569-576.

Pasonen-Seppanen SM, Maytin EV, Torronen KJ, Hyttinen JMT, Hascall VC, MacCallum DK, Kultti AH, Jokela TA, Tammi MI, Tammi RH. All-trans retinoic acid-induced hyaluronan production and hyperplasia are partly mediated by EGFR signaling in epidermal keratinocytes. J Invest Dermatol. 2008 Apr;128(4):797-807.

Piliang MP, Stoller JK. A woman with ulcerating, painful skin lesions. Cleve Clin J Med. 2008 Jun;75(6):414-422.

Rietschel RL, Fowler JF, Warshaw EM, Belsito D, DeLeo VA, Maibach HI, Marks JG, Mathias CGT, Pratt M, Sasseville D, Storrs FJ, Taylor JS, Zug KA. Detection of nickel sensitivity has increased in North American patch-test patients. Dermatitis. 2008 Jan-Feb;19(1):16-19.

Sabatino M, Zhao Y, Voiculescu S, Monaco A, Robbins P, Karai L, Nickoloff BJ, Maio M, Selleri S, Marincola FM, Wang E. Conservation of genetic alterations in recurrent melanoma supports the melanoma stem cell hypothesis. Cancer Res. 2008 Jan 1;68(1):122-131.

Sellheyer K, Krahl D. Ber-EP4 enhances the differential diagnostic accuracy of cytokeratin 7 in pagetoid cutaneous neoplasms. J Cutan Pathol. 2008 Apr;35(4):366-372.

Siemionow M, Klimczak A. Basics of immune responses in transplantation in preparation for application of composite tissue allografts in plastic and reconstructive surgery: part I. Plast Reconstr Surg. 2008 Jan;121(1):4e-12e.

Siemionow M, Sonmez E. Face as an organ. Ann Plast Surg. 2008 Sep;61(3):345-352.

Siemionow M, Klimczak A, Unal S, Agaoglu G, Carnevale K. Hematopoietic stem cell engraftment and seeding permits multi-lymphoid chimerism in vascularized bone marrow transplants. Am J Transplant. 2008 Jun;8(6):1163-1176.

Siemionow M, Nasir S. Immunologic responses in vascularized and nonvascularized skin allografts. J Reconstr Microsurg. 2008 Oct;24(7):497-505.


Siemionow M, Nasir S. Impact of donor bone marrow on survival of composite tissue allografts. Ann Plast Surg. 2008 Apr;60(4):455-462.

Siemionow M, Hivelin M. Przeszczep twarzy: Kliniczne zastosowanie [Face transplantation: clinical application of the concept] [Polish]. Pol Przegl Chir. 2008 Oct;80(10): 1041-1053.

Soliman S, Rotemberg SC, Pace D, Bark A, Mansur A, Cram A, Aly A. Upper body lift. Clin Plast Surg. 2008 Jan;35(1):107-114.

Somani AK, Swick AR, Cooper KD, McCormick TS. Severe dermatomyositis triggered by interferon beta-1a therapy and associated with enhanced type I interferon signaling. Arch Dermatol. 2008 Oct;144(10):1341-1349.

Somani AK, Somani N. Toponomics: visualizing cellular protein networks in health and disease -’A single picture is worth more than a thousand words!’. J Cutan Pathol. 2008 Aug;35(8):791-793.

Somani AK, Somani N. Toponomics: visualizing cellular protein networks in health and disease -’A single picture is worth more than a thousand words!’. J Cutan Pathol. 2008 Sep;35(9):884-886.

Somani N, Bergfeld WF. Cicatricial alopecia: classification and histopathology. Dermatol Ther. 2008 Jul;21(4): 221-237.

Somani N, Harrison S, Bergfeld WF. The clinical evaluation of hirsutism. Dermatol Ther. 2008 Sep;21(5):376-391.

Stoller JK, Piliang M. Panniculitis in alpha-1 antitrypsin deficiency: A review. Clinical Pulmonary Medicine. 2008 Mar;15(2):113-117.

Subhas N, Sundaram M, Bauer TW, Seitz WH Jr, Recht MP. Glenoid labrum ossification and mechanical restriction of joint motion: extraosseous manifestations of melorheostosis. Skeletal Radiol. 2008 Feb;37(2):177-181.

47

Outcomes 200848


Tandon YK, Somani N, Cevasco NC, Bergfeld WF. A histologic review of 27 patients with lichen planopilaris. J Am Acad Dermatol. 2008 Jul;59(1):91-98.

Warshaw EM, Furda LM, Maibach HI, Rietschel RL, Fowler JF Jr, Belsito DV, Zug KA, DeLeo VA, Marks JG Jr, Mathias CGT, Pratt MD, Sasseville D, Storrs FJ, Taylor JS. Anogenital dermatitis in patients referred for patch testing: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 1994-2004. Arch Dermatol. 2008 Jun;144(6):749-755.

Warshaw EM, Botto NC, Zug KA, Belsito DV, Maibach HI, Sasseville D, Fowler JF Jr, Storrs FJ, Taylor JS, DeLeo VA, Marks JG Jr, Mathias CGT, Pratt MD, Rietschel RL. Contact dermatitis associated with food: retrospective cross-sectional analysis of North American Contact Dermatitis Group data, 2001-2004. Dermatitis. 2008 Sep;19(5):252-260.

Warshaw EM, Belsito DV, DeLeo VA, Fowler JF Jr, Maibach HI, Marks JG, Mathias CGT, Pratt MD, Rietschel RL, Sasseville D, Storrs FJ, Taylor JS, Zug KA. North American Contact Dermatitis Group patch-test results, 2003-2004 study period. Dermatitis. 2008 May;19(3):129-136.

Warshaw EM, Schram SE, Maibach HI, Belsito DV, Marks JG Jr, Fowler JF Jr, Rietschel RL, Taylor JS, Mathias CGT, DeLeo VA, Zug KA, Sasseville D, Storrs FJ, Pratt MD. Occupation-related contact dermatitis in North American health care workers referred for patch testing: cross-sectional data, 1998 to 2004. Dermatitis. 2008 Sep;19(5):261-274.

Warshaw EM, Schram SE, Belsito DV, DeLeo VA, Fowler JF Jr, Maibach HI, Marks JG Jr, Mathias CGT, Pratt MD, Rietschel RL, Sasseville D, Storrs FJ, Taylor JS, Zug KA. Patch-test reactions to topical anesthetics: retrospective analysis of cross-sectional data, 2001 to 2004. Dermatitis. 2008 Mar;19(2):81-85.

Warshaw EM, Cook JW, Belsito DV, DeLeo VA, Fowler JF Jr, Maibach HI, Marks JG Jr, Mathias CGT, Pratt MD, Rietschel RL, Sasseville D, Storrs FJ, Taylor JS, Zug KA. Positive patch-test reactions to mixed dialkyl thioureas: cross-sectional data from the North American Contact Dermatitis Group, 1994 to 2004. Dermatitis. 2008 Jul;19(4):190-201.

Wlodarski MW, Nearman Z, Jankowska A, Babel N, Powers J, Leahy P, Volk HD, Maciejewski JP. Phenotypic differences between healthy effector CTL and leukemic LGL cells support the notion of antigen-triggered clonal transformation in T-LGL leukemia. J Leukoc Biol. 2008 Mar;83(3):589-601.

Yazici I, Cavusoglu T, Comert A, Vargel I, Cavusoglu M, Tekdemir I, Siemionow M. Maxilla allograft for transplantation: an anatomical study. Ann Plast Surg. 2008 Jul;61(1):105-113.

Yazici I, Siemionow M. The abdominal adipofascial flap: a new model for direct in vivo observation of microcirculatory hemodynamics of the abdominal fat tissue in rat. Ann Plast Surg. 2008 Jun;60(6):698-702.

Zins JE, Moreira-Gonzalez A, Parikh A, Arslan E, Bauer T, Siemionow M. Biomechanical and histologic evaluation of the Norian craniofacial repair system and Norian Craniofacial Repair System Fast Set Putty in the long-term reconstruction of full-thickness skull defects in a sheep model. Plast Reconstr Surg. 2008 May;121(5):271e-282e.

Zins JE, Morrison CM, Gonzalez AM, Altus GD, Bena J. Follow-up: orthognathic surgery. Is there a future? A national survey. Plast Reconstr Surg. 2008 Aug;122(2):555-562.

Zins JE. Invited discussion: Eyelid phenol peel: an important adjunct to blepharoplasty. Ann Plast Surg. 2008 Jan;60(1):19-20.


Zins JE, Alghoul M, Moreira Gonzalez A, Strumble P. Self-reported outcome after diode laser hair removal. Ann Plast Surg. 2008 Mar;60(3):233-238.

Zins JE, Langevin CJ, Nasir S. W poszukiwaniu doskonalej rekonstrukcji czaszki [In search of the ideal skull reconstruction] [Polish]. Pol Przegl Chir. 2008 Oct;80(10):960-974.

Zug KA, McGinley-Smith D, Warshaw EM, Taylor JS, Rietschel RL, Maibach HI, Belsito DV, Fowler JF Jr, Storrs FJ, DeLeo VA, Marks JG Jr, Mathias CGT, Pratt MD, Sasseville D. Contact allergy in children referred for patch testing: North American Contact Dermatitis Group data, 2001-2004. Arch Dermatol. 2008 Oct;144(10):1329-1336.

Zug KA, Kornik R, Belsito DV, DeLeo VA, Fowler JF Jr, Maibach HI, Marks JG Jr, Mathias CGT, Pratt MD, Rietschel RL, Sasseville D, Storrs FJ, Taylor JS, Warshaw EM. Patch-testing North American lip dermatitis patients: data from the North American Contact Dermatitis Group, 2001 to 2004. Dermatitis. 2008 Jul;19(4):202-208.

Zug KA, Rietschel RL, Warshaw EM, Belsito DV, Taylor JS, Maibach HI, Mathias CGT, Fowler JF Jr, Marks JG Jr, DeLeo VA, Pratt MD, Sasseville D, Storrs FJ. The value of patch testing patients with a scattered generalized distribution of dermatitis: retrospective cross-sectional analyses of North American Contact Dermatitis Group data, 2001 to 2004. J Am Acad Dermatol. 2008 Sep;59(3): 426-431.

49

5050

Staff Listing

Institute Chair

Frank A. Papay, MD, FACS, FAAP

Institute Quality Review Officer

Jon G. Meine, MD

Department of Dermatology

Allison T. Vidimos, RPh, MD Chair

Jon G. Meine, MD Quality Review Officer

Clinical Dermatology Section

Kenneth J. Tomecki, MD Vice Chair Wilma F. Bergfeld, MD, FACP

Jacob W. Dijkstra, MD

David Hamrock, MD

Douglas Kress, MD

Edward V. Maytin, MD, PhD

Jonelle McDonnell, MD

Melissa Piliang, MD

Najwa Somani, MD

Apra Sood, MD

James S. Taylor, MD

Dermatologic Surgery & Cutaneous Oncology Section

Philip L. Bailin, MD, MBA, FACP Section Head

Christopher Gasbarre, DO

Christine Poblete-Lopez, MD

Jon G. Meine, MD

Rebecca Tung, MD

Allison T. Vidimos, RPh, MD

Dermatopathology Section

Wilma F. Bergfeld, MD, FACP Co-Director

Steven Billings, MD Co-Director

Melissa Piliang, MD

Ralph Tuthill, MD

Industrial Dermatology Section

James S. Taylor, MD Section Head

Apra Sood, MD

Clinical Research Section

Edward V. Maytin, MD, PhD


Cutaneous Care Center


Molecular Dermatology Section

Edward V. Maytin, MD, PhD Section Head

Outcomes 2008

5151

Family Health & Surgery Center Physicians

Beachwood

Jon G. Meine, MD

Berna Remzi, MD

Rebecca Tung, MD

Chagrin Falls

Rosemary S. Keskinen, MD

Amy M. Polster, MD

Independence

Christopher Gasbarre, DO

Beverly K. Lehman Cameron, MD

Pamela Ng, MD

Christine Poblete-Lopez, MD

Carol Slover, MD

Allison T. Vidimos, RPh, MD

Lorain

John Secrist, MD

Solon

Rosemary S. Keskinen, MD

Amy M. Polster, MD

Strongsville

Irene C. Lalak, MD

Westlake

John Krebs, MD

Willoughby Hills

Jacob W. Dijkstra, MD

Ursula Stanton-Hicks, MD

Wooster

George H. Kuffner, MD


Some physicians may practice in multiple locations. For a complete list including staff photos, please visit clevelandclinic.org/staff.

Outcomes 20085252

Staff Listing

Department of Plastic Surgery

James E. Zins, MD Chair

Mark F. Hendrickson, MD Quality Review Officer

Steven L. Bernard, MD

Risal S. Djohan, MD

Raymond Isakov, MD

Shashidhar Kusuma, MD

Robert Lohman, MD

Armand R. Lucas, MD

Silvia C. Rotemberg, MD

Maria Siemionow, MD, PhD

Randall J. Yetman, MD

Family Health & Surgery Center Physicians

Beachwood

Raymond Isakov, MD

Armand R. Lucas, MD

Frank A. Papay, MD

Silvia C. Rotemberg, MD

Randall J. Yetman, MD

Independence


Lorain


Solon

Mark F. Hendrickson, MD

Raymond Isakov, MD

Strongsville

Risal S. Djohan, MD


Westlake


Some physicians may practice in multiple locations. For a complete list including staff photos, please visit clevelandclinic.org/staff.

Outcomes 20085454

Contact Information

General Patient Referral

24/7 hospital transfers or physician consults

800.553.5056

General Dermatology Appointments/Referrals

216.444.5725 or 800.223.2273, ext. 45725

Surgical Dermatology Appointments/Referrals

216.444.5724 or 800.223.2273, ext. 45724

Cutaneous Care Center

216.444.2649 or 800.223.2273, ext. 42649

Dermatology Clinical Research

216.445.8454 or 800.223.2273, ext. 58454

Dermatology Financial Coordinator

216.445.8662 or 800.223.2273, ext. 58662

Plastic Surgery Appointments/Referrals

216.444.6900 or 800.223.2273, ext. 46900

Plastic Surgery Financial Coordinator

216.445.1331 or 800.223.2273, ext. 51331

On the Web at clevelandclinic.org/dermatology and clevelandclinic.org/plastics

Additional Contact InformationGeneral Information

216.444.2200

Hospital Patient Information

216.444.2000

Patient Appointments

216.444.2273 or 800.223.2273

Medical Concierge

Complimentary assistance for out-of-state patients and families

800.223.2273, ext. 55580, or email [email protected]

Global Patient Services/International Center

Complimentary assistance for international patients and families

001.216.444.8184 or visit clevelandclinic.org/gps

Cleveland Clinic in Florida

866.293.7866

For address corrections or changes, please call

800.890.2467


Institute Locations

Main Campus

9500 Euclid Ave.

Cleveland, OH 44195

Beachwood Family Health and Surgery Center

26900 Cedar Road

Beachwood, OH 44122

Dermatology and Plastic Surgery: 216.839.3000

Chagrin Falls Family Health Center

551 E. Washington St.

Chagrin Falls, OH 44022

Dermatology: 440.893.9393

Independence Family Health Center

5001 Rockside Road

Crown Center II

Independence, OH 44131


Lorain Family Health and Surgery Center

5700 Cooper Foster Park Road

Lorain, OH 44053


Lutheran Hospital

1730 West 25th St.

Cleveland, OH 44113

Plastic Surgery: 216.363.2311

Solon Family Health Center

29800 Bainbridge Road

Solon, OH 44139

Plastic Surgery: 440.519.6800

Strongsville Family Health and Surgery Center

16761 SouthPark Center

Strongsville, OH 44136


Westlake Family Health Center

30033 Clemens Road

Westlake, OH 44145


Willoughby Hills Family Health Center

2570 SOM Center Road

Willoughby Hills, OH 44094


Cleveland Clinic Wooster

1739 Cleveland Road

Wooster, OH 44691


Outcomes 20085656

Cleveland Clinic Overview

In 2007, Cleveland Clinic restructured its practice, bundling all clinical specialties into integrated practice units called institutes. An institute combines all the specialties surrounding a specific organ or disease system under a single roof. Each institute has a single leadership and focuses the energies of multiple professionals onto the patient. From access and communication to billing and point-of-care service, institutes will improve the patient experience at Cleveland Clinic.

Cleveland Clinic’s main campus, with 50 buildings on 166 acres in Cleveland, Ohio, includes a 1,000-bed hospital, outpatient clinic, specialty institutes and supporting labs and facilities. Cleveland Clinic also operates 15 family health centers; eight community hospitals; one affiliate hospital; a rehabilitation hospital for children; a 150-bed hospital and clinic in Weston, Fla.; and health and wellness centers in Palm Beach, Fla., and Toronto, Canada. Cleveland Clinic Abu Dhabi (United Arab Emirates), a multispecialty care hospital and clinic, is scheduled to open in late 2012.

At the Cleveland Clinic Lerner Research Institute, hundreds of principal investigators, project scientists, research associates and postdoctoral fellows are involved in laboratory-based, translational and clinical research. Total annual research expenditures exceed $244 million from federal agencies, non-federal societies and associations, endowment funds and other sources. In an effort to bring research from bench to bedside, Cleveland Clinic physicians are involved in more than 2,400 clinical studies at any given time.

Now in its fifth year of existence, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University offers all students full tuition scholarships. The program will graduate its first 29 students as physician-scientists in 2009.

Cleveland Clinic is consistently ranked among the top hospitals in America by U.S.News & World Report, and our heart and heart surgery program has been ranked No. 1 since 1995.

For more information about Cleveland Clinic, please visit clevelandclinic.org


Resources for Physicians

Cleveland Clinic Secure Online Services

Cleveland Clinic uses state-of-the-art digital information systems to offer secure online services such as online medical second opinions, medical record access, patient treatment progress for referring physicians (see below), and imaging interpretations by our subspecialty trained radiologists. For more information, please visit eclevelandclinic.org.

MyChart This secure online tool connects patients to their own health information from the privacy of their home any time, day or night. Some features include renewing prescriptions, reviewing test results and viewing medications, all online. For the convenience of physicians and patients across the country, MyChart now offers a secure connection to GoogleTM Health. Google Health users can securely share personal health information with Cleveland Clinic, and record and share the details of their Cleveland Clinic treatment with the physicians and healthcare providers of their choice. To establish a MyChart account, visit clevelandclinic.org/mychart.

DrConnect Whether you are referring from near or far, DrConnect streamlines communication from Cleveland Clinic physicians to your office. This complimentary online tool offers secure access to your patient’s treatment progress at Cleveland Clinic. With one-click convenience, you can track your patient’s care using the secure DrConnect website. To establish a DrConnect account, visit clevelandclinic.org/drconnect or email [email protected].

MyConsult Online Medical Second Opinion This secure online service provides specialist consultations from our Cleveland Clinic experts and remote medical second opinions for more than 1,000 life-threatening and life-altering diagnoses. MyConsult is particularly valuable for people who wish to avoid the time and expense of travel. For more information, visit clevelandclinic.org/myconsult, email [email protected] or call 800.223.2273, ext 43223.

Critical Care Transport: Anywhere in the world

Cleveland Clinic’s critical care transport team serves critically ill and highly complex patients across the globe. The transport fleet comprises mobile ICU vehicles, helicopters and fixed-wing aircraft. The transport teams are staffed by physicians, critical care nurse practitioners, critical care nurses, paramedics and ancillary staff, and are customized to meet the needs of the patient. Critical care transport is available for children and adults. To arrange a transfer for STEMI (ST elevated myocardial infarction), acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemorrhage) or aortic syndromes, call 877.279.CODE (2633). For all other transfers, call 216.444.8302 or 800.553.5056.

CME Opportunities: Live and Online

Cleveland Clinic’s Center for Continuing Education’s website, clevelandclinicmeded.com, offers hundreds of convenient, complimentary learning opportunities, from webcasts and podcasts to a host of medical publications including the Disease Management Project Online Medical Textbook, with more than 150 chapters. The site also offers a schedule of live CME courses, including international summits that focus on key areas of translational research. Many live CME courses are hosted in Cleveland, an economical option for business travel. Physicians can manage their CME credits by using the myCME Web Portal. Available 24/7, the site offers CME opportunities to medical professionals across the globe.

9500 Euclid Avenue, Cleveland, OH, 44195

© The Cleveland Clinic Foundation 2009

Cleveland Clinic is a nonprofit multispecialty academic medical center. Founded in 1921, it is dedicated to providing quality specialized care and includes an outpatient clinic, a hospital with more than 1,000 staffed beds, an education institute and a research institute.

Please visit us on the Web at clevelandclinic.org.

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