Evaluating Resource Utilization with Free or Pedicled Perforator Flaps in Distal Leg Reconstruction.
| Autor: | Hsiao JC; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan., Zelenski NA; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan.; Department of Orthopedic Surgery, Emory University, Atlanta, Georgia., Tseng YJ; Department of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan., Hsu CC; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan., Chen SH; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan., Lin CH; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan., Lin CH; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan. |
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| Jazyk: | angličtina |
| Zdroj: | Journal of reconstructive microsurgery [J Reconstr Microsurg] 2023 Jul; Vol. 39 (6), pp. 462-471. Date of Electronic Publication: 2022 Dec 03. |
| DOI: | 10.1055/s-0042-1759525 |
| Abstrakt: | Background: The decision between local and free tissue coverage for distal lower leg defects has long been dictated by the location and size of defects. Recent reports of distal defects treated successfully with pedicled perforator flaps demonstrate equivalent clinical outcomes; however, the complication rate can be high. The goal of this study was to evaluate the cost equivalence of free versus pedicled perforator flap to assist decision-making and guide clinical care. Methods: The institutional database was searched for patients with acute injury over the distal lower extremity requiring free or pedicled perforator flap. Demographic, clinical, and total resource cost was gathered. Patients were matched to Gustilo-Anderson or Arbeitsgemeinschaft fur Osteosynthesefragen classification as well as size of defect and outcomes, and cost compared. Results: We have included 108 free flaps and 22 pedicled perforator flaps in the study. There was no difference in complication rate between groups. Free flaps had significantly more reoperations, required longer operative time, and had longer intensive care unit (ICU) care with higher cost of surgery and overall cost than pedicled flaps. When controlling for size of defect, surgical cost remained significantly different between groups ( p = 0.013), but overall cost did not. Multivariable regression analysis indicated flap type to be the primary driver of cost of surgery, while body mass index elevated the total cost. Conclusion: Pedicled perforator flap coverage for small to medium-sized defects (< 70 cm 2 ) is a viable and cost-effective option for distal lower leg soft tissue reconstruction after acute traumatic injury with similar clinical outcomes and shorter operative duration and ICU stay. Competing Interests: None declared. (Thieme. All rights reserved.) |
| Databáze: | MEDLINE |
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