scholarly journals Costs and renumeration of osteomyelitis treatment involving free flaps: implications of return to theatre

2018 ◽  
Vol 3 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Rebecca Shirley ◽  
Janka Fazekas ◽  
Martin McNally ◽  
Alex Ramsden
Keyword(s):  
Chronic Osteomyelitis ◽  
Significant Risk ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Consecutive Series ◽  
Financial Loss ◽  
Tissue Transfer ◽  
Uk National Health Service ◽  
The Uk ◽  
Almost All

Abstract. Aim: This study aimed to define the costs of surgical management of chronic osteomyelitis where free tissue transfer was required in addition to debridement of bone, particularly the increased costs incurred by a return to theatre. We hypothesised that there would be a significantly greater cost when patients required re-exploration for vascular compromise.Method: We retrospectively analysed the costs of a consecutive series of sixty patient episodes treated at the Bone Infection Unit in Oxford from 2012 to 2015. Treatment involved excision of osteomyelitis with free tissue transfer for immediate soft tissue cover. We compared the costs of uncomplicated cases with those who returned to theatre and determined the profit / loss for the hospital from renumeration through the UK National Health Service Tariff Structure.Results: Hospital income according to UK HRG tariff was compared to the actual cost of treatment and these 60 cases were significantly underfunded overall (P < 0.005). In just 1 case, the cost to the hospital was completely covered by tariff.Six patients (10%) returned to theatre for urgent flap re-exploration with five flaps salvaged and one failed, requiring another free flap reconstruction (1.7%). These six patient episodes had a significantly higher mean cost compared to the uncomplicated cases. The average financial loss to the hospital for patients who did return to theatre was £19401 (range £8103 to £48380) and in those who did not was £9600 (range - £600 to £23717). The case requiring further free tissue transfer cost a total of £74158, £48380 more than the hospital was paid: the most extreme discrepancy. The overall loss for this group of 60 patients was £610 090.Conclusions: Surgery for chronic osteomyelitis is multidisciplinary, complex and therefore expensive with a significant risk of complications. However, this study demonstrates that the hospital currently makes a financial loss on almost all patients but especially if flap complications occur. This study has implications for the long term viability of specialist units treating this important disease.

scholarly journals Free Tissue Transfer in Pressure Ulcer Reconstruction: A Systematic Review

2021 ◽  
Vol 06 (01) ◽  
pp. e35-e39
Author(s):  
Chelsi Robertson ◽  
Charles Patterson ◽  
Hugo St. Hilaire ◽  
Frank H. Lau
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Final Analysis ◽  
The United States ◽  
Local Flap ◽  
Recurrence Rates ◽  
Tissue Transfer ◽  
Cochrane Database

Abstract Background Pressure ulcers (PUs) affect 2.5 million people in the United States annually and incur health-care costs of 11 billion dollars annually. Stage III/IV PU often require local flap reconstruction. Unfortunately, PU recurrence is common following reconstruction; recurrence rates as high as 82% have been reported. When local flap options are inadequate, free tissue transfer may be indicated but the indications have yet to be delineated. To develop evidence-based guidelines for the use of free flaps in PU reconstruction, we performed a systematic review. Methods A systematic review of the available English-language, peer-reviewed literature was conducted using PubMed/MEDLINE, Google Scholar, Scopus, EMBASE, and the Cochrane Database of Systematic Reviews. Articles were manually reviewed for relevance. Results Out of 272 articles identified, 10 articles were included in the final analysis. Overall, this systematic review suggests that free-flap PU reconstruction yields fewer recurrences compared with local flaps (0–20 vs. 13–82%). Further, several types of free flaps for PU reconstruction were identified in this review, along with their indications. Conclusion Free tissue transfer should be considered for recurrent PU. We offer specific recommendations for their use in PU reconstruction.

Chronic long bone osteomyelitis

2011 ◽  
Author(s):  
Peter Calder
Keyword(s):  
Soft Tissues ◽  
Chronic Osteomyelitis ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Autologous Bone Graft ◽  
Bone Transport ◽  
Soft Tissue Defect ◽  
Long Bone ◽  
Space Management ◽  
Secondary Intention

Pathological features of chronic osteomyelitis♦ Necrotic bone♦ Compromised soft tissues with reduction in vascularity♦ Ineffective host response♦ Sequestrum formation♦ New bone formation from viable periosteum and endosteum♦ Formation of involucrum:Treatment principles in chronic osteomyelitis♦ Surgical debridement – remove all devitalized necrotic tissue♦ Dead space management:• Soft tissue defect – avoid healing by secondary intention. Consider local and free flaps• Bone defects – small structural with autologous bone graft, consider Papineau ‘open bone grafting’ where free tissue transfer is not an option, distraction osteogenesis with bifocal and bone transport for large defects including fibula transfer♦ Bone stability – movement needs to be eliminated♦ Antibiotic therapy – based on culture and sensitivity, local administration with PMMA beads or collagen sponge, Lautenbach procedure in resistant cases.

scholarly journals Microvascular Free Tissue Transfer in the Reconstruction of Scalp and Lateral Temporal Bone Defects

2011 ◽  
Vol 4 (4) ◽  
pp. 179-187 ◽  
Author(s):  
Daniel A. O'Connell ◽  
Marita S. Teng ◽  
Eduardo Mendez ◽  
Neal D. Futran
Keyword(s):  
Temporal Bone ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Wound Dehiscence ◽  
Free Flaps ◽  
Bone Defects ◽  
Unique Challenge ◽  
Cosmetic Results ◽  
Tissue Transfer ◽  
Anterolateral Thigh

Defects of the scalp and lateral temporal bone (LTB) represent a unique challenge to the reconstructive surgeon. Simple reconstructive methods such as skin grafts, locoregional flaps, or tissue expanders are often not feasible due to a myriad of reasons. Vascularized free tissue transfer coverage offers distinct advantages in managing these defects. A retrospective case series was performed on all patients at the University of Washington Medical Center who had scalp or LTB defects reconstructed with free tissue transfer from May 1996 to July 2009. Cases were analyzed for defect characteristics, flap type, vessel selection, radiation status, dural exposure, complications, and outcomes. Sixty-eight free flaps were performed in 65 patients with scalp or LTB defects. Twenty-two resections included craniotomy, and 48 patients had pre- or postoperative radiation. Defects ranged from 6 to 836 cm2. All flaps (46 latissimus, 11 rectus, 4 radial forearm, 6 anterolateral thigh, and 1 omental) were transferred successfully. Vein grafts were required in five cases. Complications included delayed flap failure requiring secondary reconstruction, neck hematoma, venous thrombosis, skull base infection, large wound dehiscence, small wound dehiscence, donor site hematoma and seroma, and cerebrospinal fluid leak. Cosmetic results were consistent and durable. Microvascular free tissue transfer is a safe, reliable method of reconstructing scalp and LTB defects and offers favorable cosmetic results. We favor the use of latissimus muscle-only flap with skin graft coverage for large scalp defects and rectus or anterolateral thigh free flaps for lateral temporal bone defects.

Compromised microvascular free flaps; salvage using Fogarty vascular catheter thrombectomy

2020 ◽  
Vol 13 (12) ◽  
pp. e239251
Author(s):  
Santhosh Rao ◽  
Nitin Kumar Kashyap ◽  
Chinmaya Panda ◽  
Naveen Kumar
Keyword(s):  
Free Flap ◽  
Thrombus Formation ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Tissue Transfer ◽  
Microvascular Free Flaps ◽  
Flap Perfusion

Compromised free flap perfusion secondary to thrombus formation is a routinely encountered complication in microvascular free tissue transfer. Various modalities were tried out prophylactically to prevent thrombus formation, and likewise, various methods are tried for salvaging the flap with effective thrombectomy. We present the use of Fogarty vascular catheter for thrombectomy and effective salvage of the flap.

scholarly journals Free Tissue Reconstruction of the Scalp

2019 ◽  
Vol 33 (01) ◽  
pp. 067-071 ◽  
Author(s):  
Mofiyinfolu Sokoya ◽  
Emily Misch ◽  
Aurora Vincent ◽  
Weitao Wang ◽  
Sameep Kadakia ◽  
...  
Keyword(s):  
Free Tissue Transfer ◽  
Free Flaps ◽  
Advantages And Disadvantages ◽  
Scalp Reconstruction ◽  
Tissue Transfer ◽  
Scalp Defects ◽  
Calvarial Defects ◽  
Reconstructive Option ◽  
Tissue Reconstruction

AbstractReconstruction of scalp defects can be accomplished by many methods, but larger defects, especially those in which the periosteum is absent or calvarial defects are present, require free tissue transfer. Various methods of scalp reconstruction, as guided by the defect components and size, are presented herein, with a focus on free tissue transfer. Different free flaps for scalp reconstructed are described with a comparison of their advantages and disadvantages. Overall, free tissue transfer for scalp defects provides a reliable, durable, and cosmetically adequate reconstructive option.

scholarly journals Use of the Retrograde Recipient Vein for Additional Outflow in Free Tissue Transfer

2020 ◽  
Vol 05 (01) ◽  
pp. e1-e6
Author(s):  
Tetsuji Uemura ◽  
Mamoru Kikuchi ◽  
Hidetaka Watanabe ◽  
Tetsu Yanai
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Blood Perfusion ◽  
Free Flaps ◽  
Successful Outcome ◽  
Venous Anastomosis ◽  
Venous Flow ◽  
Flap Transfer ◽  
Tissue Transfer ◽  
Free Flap Transfer

Abstract Background The selection of appropriate recipient vessels is essential to the successful outcome of free flap transfer. To improve blood perfusion after reconstruction and reduce the risk of postoperative obstruction of flap vessels, multiple vessels should be chosen as candidate recipients. Methods For certainty of venous drainage, we have been performing venous anastomosis to the distal end of the recipient vein to utilize the reverse venous flow. Results A total of 48 cases of reconstruction of the head and neck or breast region with free flaps using retrograde venous anastomosis were performed. The method possibly improves flap circulation and the success rate of the free tissue transfer and reduces the need to extend surgery to search for multiple recipient veins. Conclusion We emphasized that retrograde limb of vein is useful as a second and/or rescued recipient in free tissue transfer. Retrograde venous anastomosis is a fine and reasonable option when appropriate recipient vessels cannot be found near the defect in the head and neck such as frozen neck or breast region.

scholarly journals Microsurgical free tissue transfer as avaluable reconstructive procedure in foot reconstruction

2007 ◽  
Vol 40 (02) ◽  
pp. 141-146
Author(s):  
mohamed el-shazly ◽  
mohamed makboul
Keyword(s):  
Free Flap ◽  
Motor Vehicle ◽  
Donor Site ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Vehicle Accidents ◽  
Tissue Transfer ◽  
Scapular Flap ◽  
Radial Forearm ◽  
Foot Reconstruction

ABSTRACT Background: owing to the limited soft tissue donor sites in the foot area, the use of microsurgical tissue transfer is frequently becoming mandatory in this area, especially in cases of massive defects due to the common motor vehicle accidents in the territory of upper egypt. free flaps offer a great variety of available tissues to cover larger, multifocal or multistructural defects. they also improve the perfusion of the infected poorly perfused areas.Objectives: in this study, we tried to evaluate foot defects according to their size, shape and site and to determine the general and specific parameters of free tissue transfer to the foot area in concomitance with the patients needs.Materials and methods: eleven patients were included in this study. for each patient, complete history was taken, general and local examination, photographic documentation, laboratory investigations, imaging and other investigations were performed. free flap transfers were applied in all cases as follows: latissimus dorsi flap in five cases, rectus abdominis flap in three cases, scapular flap in one case, gracilis flap in one case and radial forearm flap in one case.Results: nine flaps survived. no infection or donor site complications were recorded. every patient had the optimum free flap as regards the defect size, site, depth, condition, shape, donor site availability and the recipient vessels′ condition.Conclusion: the study of the optimum free flap for foot reconstruction in relation to the defect present and patient conditions is crucial to have significant results.

Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases

2019 ◽  
Vol 36 (02) ◽  
pp. 127-135 ◽  
Author(s):  
Matthias Wähmann ◽  
Melodie Wähmann ◽  
Dominic Henn ◽  
Lingyun Xiong ◽  
Christoph Hirche ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Complications ◽  
Geriatric Patients ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Old Patients ◽  
Very Old ◽  
Patients Âgés ◽  
Tissue Transfer ◽  
Very Old Patients

Abstract Background In elderly patients, complex soft tissue defects are increasingly observed due to the prolonged life expectancy and accompanying comorbidities. The aim of this study is to evaluate whether free tissue transfer is safe in very old patients without additional risk and complications. Methods All patients older than 65 years undergoing free tissue transfer between November 2007 and September 2016 were reviewed in a retrospective study. Two cohorts were compared regarding perioperative morbidity and postoperative outcome (cohort 1 [old patients, ages 65–79]; cohort 2 [very old patients, ages ≥ 80]). Results In total, 256 patients were included in the study (cohort 1 [n = 217]; cohort 2 [n = 39]). Overall, 262 free flaps were performed due to a second microsurgical reconstruction in six cases. No statistically significant differences between cohorts were observed regarding surgical complications, total flap losses, and mortality. Detailed evaluation of cohort 2 revealed a significant learning curve during the observation period regarding the perioperative management and procedure of soft tissue reconstruction: operation length as well as postoperative intensive care unit stay decreased significantly over time (p < 0.05) and also surgical complications showed a positive trend (p = 0.07). We ascertained a shift toward a “more reliable” flap selection from predominantly anterolateral thigh flap) to axial flaps such as rectus abdominis and latissimus dorsi flaps. Conclusion Our study showed that age is not associated with an increased risk of postoperative complications. Reliable muscle free flaps, two-stage procedures, and safe vascular supply are important strategic aspects to achieve microvascular tissue transfer with high success rates in geriatric patients.

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