title: Reconstruction of limited soft-tissue defect with open tibial fracture in the distal third of the leg: a cost and outcome study.
abstract: This study was conducted to analyze the cost and outcome of free-tissue transfers versus local muscle flaps for reconstruction of limited soft-tissue defects associated with tibial fractures in the distal third of the leg. Twelve adult patients underwent either free (n = 6) or local muscle (n = 6) flap reconstruction were retrospectively reviewed. Total operative time for local muscle flap reconstruction was 215 +/- 47 minutes compared with 450 +/- 90 minutes (P < 0.0002) for free-muscle transfer. Median length of hospital stay after reconstruction was 7 days for local muscle flap compared with 9 days for free-muscle transfer. Total cost of the local muscle flap procedure was US dollars 11,729 +/- US dollars 4460 compared with US dollars 19,989 +/- US dollars 3295 (P < 0.0004) for free-flap reconstruction. Five of 6 patients in each group had excellent soft-tissue contours. Fracture healing was evident in all patients of each group. Thus, a local muscle flap for reconstruction of a limited distal tibial wound appears to be more cost-effective than free-tissue transfer because of equivocal outcomes achieved but at approximately half of the cost.
authors.affiliation: Division of Plastic Surgery, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Thornton
authors.forename: William J
authors.initials: WJ
authors.lastname: Rosenblum
authors.forename: Lee L Q
authors.initials: LL
authors.lastname: Pu
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003646:Debridement; D005260:Female; D005597:Fractures, Open / Q000191:economics / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D007629:Kentucky; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000601:surgery; D017695:Soft Tissue Injuries / Q000191:economics / Q000601:surgery*; D013524:Surgical Flaps / Q000191:economics; D013978:Tibial Fractures / Q000191:economics / Q000601:surgery*; D016896:Treatment Outcome