A prospective randomized cost billing comparison of local fasciocutaneous perforator versus free Gracilis flap reconstruction for lower limb in a developing economy.
Distal half leg complex wounds are usually a formidable problem that necessitates either local or free flap coverage. The aim of this study was to compare cost billing charges in free Gracilis flap (fGF) and local fasciocutaneous perforator flap (lFPF) in reconstructing complex soft tissue leg and foot defects.


METHODS
Thirty consecutive adult (>15-year-old) patients with soft tissue defects in the leg and/or foot requiring tissue coverage with a flap in the period between 2012 and 2015 were randomly assigned (block randomization) to either an fGF or lFPF procedure. The outcome measures addressed were total billed charges costs, perioperative billed charges cost, partial or complete flap loss, length of hospital stay, inpatient postsurgical care duration, complications, operating time and number of operative scrub staff.


RESULTS
One patient suffered from complete flap loss in each group. Reconstruction with lFPF showed total lower billed charges costs by 62% (2509 USD) (p < 0.001) and perioperative billed charges cost by 54% (779 USD) (p < 0.001), and shorter total hospital stay (36.5 days; p < 0.001), inpatient postsurgical care duration (6.4 days; p < 0.001), operating time (4.3 h; p < 0.001) and fewer scrub staff (2.2 persons; p < 0.001).


CONCLUSIONS
These results suggest that neither flap is totally superior to the other; the choice should instead be based on the outcome sought and logistics. lFPF requires lower billed charges cost and resource use and saves operative time and personnel and reduces length of hospital stay. Our approach changed towards using perforator flaps in medium-sized defects, keeping the free flap option for larger defects.
Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt; The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Electronic address: islam.abdelrahman@liu.se.
Islam
I
Abdelrahman
Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt.
Amr
A
Moghazy
Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt.
Ashraf
A
Abbas
Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt; The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Moustafa
M
Elmasry
Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt.
Osama
O
Adly
Plastic Surgery Unit, Surgery Dept., Suez Canal University, Ismailia, Egypt.
Mohamed
M
Elbadawy
The Burn Centre, Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Ingrid
I
Steinvall
Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Burn Centre, Department of Hand, Plastic Surgery and Intensive Care, Linköping University, Linköping, Sweden.
Folke
F
Sjoberg
D000328:Adult; D003365:Costs and Cost Analysis; D003906:Developing Countries; D004534:Egypt; D005249:Fees and Charges; D005260:Female; D000071976:Gracilis Muscle; D006801:Humans; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000379:methods; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000191:economics*; D055815:Young Adult
Complex soft tissue defects; Cost; Free Gracilis flap; Hospital stay; Lower limb reconstruction; Perforator flap