Comparative Effectiveness Analysis of Complex Lower Extremity Reconstruction: Outcomes and Costs for Biologically Based, Local Tissue Rearrangement, and Free Flap Reconstruction. Plast Reconstr Surg 2020 Mar;145(3):608e-616e
Date
02/26/2020Pubmed ID
32097331Pubmed Central ID
PMC7043725DOI
10.1097/PRS.0000000000006589Scopus ID
2-s2.0-85080029911 (requires institutional sign-in at Scopus site) 26 CitationsAbstract
BACKGROUND: Various surgical techniques exist for lower extremity reconstruction, but limited high-quality data exist to inform treatment strategies. Using multi-institutional data and rigorous matching, the authors evaluated the effectiveness and cost of three common surgical reconstructive modalities.
METHODS: All adult subjects with lower extremity wounds who received bilayer wound matrix, local tissue rearrangement, or free flap reconstruction were retrospectively reviewed (from 2010 to 2017). Cohorts' comorbidities and wound characteristics were balanced. Graft success at 180 days was the primary outcome; readmissions, reoperations, and costs were secondary outcomes.
RESULTS: Five hundred one subjects (166 matrix, 190 rearrangement, and 145 free flap patients) were evaluated. Matched subjects (n = 312; 104/group) were analyzed. Reconstruction success at 180 days for matrix, local tissue rearrangement, and free flaps was 69.2 percent, 91.3 percent, and 93.3 percent (p < 0.001), and total costs per subject were $34,877, $35,220, and $53,492 (p < 0.001), respectively. Median length of stay was at least 2 days longer for free flaps (p < 0.0001). Readmissions and reoperations were greater for free flaps. Local tissue rearrangement, if achievable, provided success at low cost. Free flaps were effective with large, traumatic wounds but at higher costs and longer length of stay. Matrices successfully treated older, obese patients without exposed bone.
CONCLUSIONS: Lower extremity reconstruction can be performed effectively using multiple modalities with varying degrees of success and costs. Local tissue rearrangement and free flaps demonstrate success rates greater than 90 percent. Bilayer wound matrix-based reconstruction effectively treats a distinct patient population.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Author List
Kozak GM, Hsu JY, Broach RB, Shakir S, Calvert C, Stranix JT, Messa C 4th, Levin LS, Serletti JM, Kovach SJ, Fischer JPAuthor
Sameer Shakir MD Assistant Professor in the Plastic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Chondroitin Sulfates
Collagen
Female
Free Tissue Flaps
Graft Survival
Health Care Costs
Humans
Leg Injuries
Length of Stay
Male
Middle Aged
Patient Readmission
Reoperation
Retrospective Studies
Severity of Illness Index
Skin Transplantation
Skin, Artificial
Treatment Outcome
