title: Cost-effectiveness of a topically applied pre-operative tissue expansion device for radial forearm free flaps: a cohort study.
abstract: OBJECTIVE
  The objective of this study is to test the hypothesis that using a non-invasive and inexpensive pre-operative tissue expansion device (DynaClose) for radial forearm free-flap donor sites will result in a significant reduction in the cost of both in-hospital and out-of-hospital wound care compared with that of unexpanded radial forearm free-flap donor sites.
  
  
  METHODS
  A cohort study consisting of patients previously randomised in a randomised controlled trial. An intention to treat design was utilised.
  
  
  METHODS
  A large tertiary care centre in eastern Ontario, Canada.
  
  
  METHODS
  Thirty-four patients presenting to Otolaryngology Head and Neck clinic were enroled. Of these patients, 29 were previously enroled in a randomised controlled trial, while an additional five patients were enroled and randomised for the purpose of this study.
  
  
  METHODS
  Patients were randomised to either the treatment (pre-operative tissue expansion, DynaClose Expansion System) or control group.
  
  
  METHODS
  Wound care costs (in US dollars) were calculated for all patients for both in-hospital care and for patients requiring home care. Non-parametric data analysis was utilised for statistical assessment.
  
  
  RESULTS
  There was a 93% reduction in the use of split-thickness skin grafts in the treatment group. There was a significant reduction in total wound care cost for patients in the treatment group versus the control group (P < 0.0001). Patients in the treatment group required a mean (SD) total of $36.00 (23.50) per patient, while the control group required $277.00 (325.00) of wound care. After excluding the cost of home care, the treatment group continued to have a significant reduction in total and in-hospital wound care costs compared with the control group (P < 0.001).
  
  
  CONCLUSIONS
  Using a simple, inexpensive and non-invasive method of pre-operative tissue expansion results in a significant reduction in the costs of wound care for both in-hospital and out-of-hospital treatment. The DynaClose dynamic skin expansion system results in a cost-effective method to reduce the need of a split-thickness skin graft for coverage of a radial forearm free-flap donor site.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa, Ottawa, ON, Canada.
authors.forename: J P
authors.initials: JP
authors.lastname: Bonaparte
authors.forename: M
authors.initials: M
authors.lastname: Corsten
authors.forename: M
authors.initials: M
authors.lastname: Allen
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000601:surgery*; D005543:Forearm Injuries / Q000601:surgery*; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000191:economics* / Q000379:methods; D016038:Skin Transplantation / Q000379:methods; D015626:Tissue Expansion / Q000191:economics / Q000295:instrumentation*; D015625:Tissue Expansion Devices / Q000191:economics*; D016896:Treatment Outcome; D014945:Wound Healing