The application of computer-enhanced imaging to improve preoperative counselling and informed consent in children considering bone anchored auricularprosthesis surgery

Objectives: Bone anchored auricular prostheses have become a valuable optio n in the treatment of congenital and acquired deformities of the pinna. How ever, preoperative counselling and informed consent remains a challenging i ssue. Until recently it has been difficult to provide the child with a real istic prediction of their own postoperative appearance. This is particularl y relevant when a remnant pinna needs to be excised prior to the second sta ge. The potential for psychological repercussions and the possibility that remnant excision might compromise future autologous tissue reconstruction m ake it imperative that the decision to proceed with surgery is founded on t he best possible information. Methods: The authors describe the use of comp uter enhanced images using the Adobe Photoshop (Apple Mac. Inc.) software p ackage to provide such a preview. This technique is used in the outpatient clinic as an adjunct to counselling provided by clinic staff and is reinfor ced by meeting children who have already enrolled on to the implant program me. Children are encouraged to follow the stages of their planned operation on the computer screen, providing an accurate insight into the physical co nsequences of surgery. Results: Our experiences suggest that this approach has encouraged a better qualitative understanding of implant surgery which has helped to foster the on-going commitment that is required to maintain a long-lasting, trouble-free implant site. Conclusions: This application of the Adobe Photoshop package has strengthened our basis for a personal infor med consent and has provided an opportunity to lessen the adverse psycholog ical consequences of such irreversible surgery. It is commended for its sim plicity as it employs established software to enhance photographic prints o r slides taken from the child's clinical records. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.