The Use of Integra Dermal Regeneration Template Versus Flaps for Reconstruction of Full-Thickness Scalp Defects Involving the Calvaria: A Cost-Benefit Analysis

Autor: J. Tesei, M. Francescon, M. Schiavon, G. Salloum, F. Barbone, R. Baraziol, D. Drigo, E. Fraccalanza
Rok vydání: 2016
Předmět:
Male
Cost-Benefit Analysis
Dentistry
Surgical Flaps
Cohort Studies
030207 dermatology & venereal diseases
0302 clinical medicine
Injury Severity Score
Postoperative Complications
Interquartile range
Dermal Matrix
Hospital Costs
Aged
80 and over
Cost benefit
Integra
Scalp reconstruction
Surgery
Chondroitin Sulfates
Soft tissue
Skin Transplantation
Middle Aged
Plastic surgery
medicine.anatomical_structure
Treatment Outcome
030220 oncology & carcinogenesis
Full thickness
Original Article
Female
Collagen
Reconstructive surgery
medicine.medical_specialty
Calvaria
Free Tissue Flaps
Risk Assessment
03 medical and health sciences
medicine
Regeneration
Humans
Aged
Retrospective Studies
Skin
Artificial
Wound Healing
Scalp
business.industry
Regeneration (biology)
Skull
Retrospective cohort study
Plastic Surgery Procedures
Otorhinolaryngology
business
Follow-Up Studies
Zdroj: Aesthetic Plastic Surgery
ISSN: 1432-5241
Popis: Background INTEGRA® Dermal Regeneration Template is a well-known and widely used acellular dermal matrix. Although it helps to solve many challenging problems in reconstructive surgery, the product cost may make it an expensive alternative compared to other reconstruction procedures. This retrospective study aims at comparing INTEGRA-based treatment to flap surgery in terms of cost and benefit. Patients and Methods We considered only patients treated for scalp defects with bone exposure in order to obtain two groups as homogeneous as possible. We identified two groups of patients: 17 patients treated with INTEGRA and 18 patients treated with flaps. All patients were admitted in our institution between 2004 and 2010, and presented a defect of the scalp following trauma or surgery for cancer, causing a loss of the soft tissues of the scalp with bone exposure without pericranium. To calculate the cost in constant euros of each treatment, three parameters were evaluated for each patient: cost of the surgical procedure (number of doctors and nurses involved, surgery duration, anesthesia, material used for surgery), hospitalization cost (hospitalization duration, dressings, drugs, topical agents), and outpatient cost (number of dressing changes, personnel cost, dressings type, anti-infective agents). The statistical test used in this study was the Wilcoxon Mann–Whitney (α = 0.05). Results No significant difference was characterized between the two groups for gender, age, presence of diabetes, mean defect size, and number of surgical procedures. All patients healed with good quality and durable closure. The median total cost per patient was €11,121 (interquartile range (IQR) 8327–15,571) for the INTEGRA group and €7259 (IQR 1852–24,443) for the flap group (p = 0.34). A subgroup of patients (six patients in the INTEGRA group and five patients in the flap group) showing defects larger than 100 cm2 were considered in a second analysis. Median total cost was €11,825 (IQR 10,695–15,751) for the INTEGRA group and €23,244 (IQR 17,348–26,942) for the flap group. Conclusion Both treatments led to a good healing of the lesions with formation of soft and resistant tissue. No significant difference was characterized between the two groups for days of hospitalization and costs. In cases of patients with defects larger than 100 cm2 for whom major surgery is needed, the treatment with INTEGRA seemed to be less expensive than the treatment with free flaps or pedicle flaps. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A5 online Instructions to Authors.www.springer.com/00266.
Databáze: OpenAIRE
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