Synchronous circular frame stabilisation and microsurgical soft tissue reconstruction for open lower limb fractures-A cost analysis and description of the surgical technique

Sanita Sandhu; Emily Coyne; Paul Harwood; Waseem Bhat; Daniel Wilks

doi:10.1016/j.injury.2022.08.044

Synchronous circular frame stabilisation and microsurgical soft tissue reconstruction for open lower limb fractures-A cost analysis and description of the surgical technique

Injury. 2022 Nov;53(11):3833-3837. doi: 10.1016/j.injury.2022.08.044. Epub 2022 Aug 24.

Authors

Sanita Sandhu¹, Emily Coyne¹, Paul Harwood², Waseem Bhat³, Daniel Wilks⁴

Affiliations

¹ The University of Leeds, Woodhouse Lane, Leeds, UK, LS2 9JT.
² The University of Leeds, Woodhouse Lane, Leeds, UK, LS2 9JT; Department of orthopaedic surgery, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, UK, LS1 3EX.
³ The University of Leeds, Woodhouse Lane, Leeds, UK, LS2 9JT; Department of plastic surgery, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, UK, LS1 3EX.
⁴ The University of Leeds, Woodhouse Lane, Leeds, UK, LS2 9JT; Department of plastic surgery, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, UK, LS1 3EX. Electronic address: daniel.wilks@rch.org.au.

PMID: 36041922
DOI: 10.1016/j.injury.2022.08.044

Abstract

Introduction: Current surgical paradigms for ortho-plastic management of IIIB open tibial fractures make compromises. Often, definitive circular frame stabilisation is delayed until the soft tissue envelope is secure to allow access for further soft tissue reconstruction if required. This delay has potential clinical and cost implications. A previous study showed acute circular frame stabilisation performed concurrently or before soft tissue reconstruction was feasible without additional soft tissue reconstruction problems. This study examines potential resource savings using this approach.

Methods: All open tibial fractures managed by circular fixator and microsurgical soft tissue reconstruction between April 2015 and June 2019 were identified from a prospectively maintained database. Those receiving circular frame stabilisation with synchronous microsurgical soft tissue reconstruction were considered cases; those in whom the frame stabilisation was delayed were controls. Cost data were derived from the Patient Level Information and Costing System. Salvage cases and those with incomplete treatment were excluded.

Results: Nine cases and 25 controls were evaluated. No statistically significant difference was observed between groups in terms of age, sex, injury severity score, time to debridement, time to coverage, length of follow up, or time to union. Median length of stay was 13.3 and 19.7 days for cases and controls respectively (p<0.01). Cases required fewer procedures (2.3) compared to controls (4.5) (p<0.001). The cost of care was less for cases (£25,527) than controls (£32,952) (p <0.05). No cases returned to theatre with flap failure or flap compromise. Complications were similar between groups.

Conclusion: In suitable patients, synchronous circular frame stabilisation and microsurgical soft tissue reconstruction is a safe, clinically effective, and cost-saving option.

Keywords: Free flap; Ilizarov; Lower limb; Major trauma; Microsurgery; Open fracture; Reconstruction.

MeSH terms

Costs and Cost Analysis
Debridement / methods
Fractures, Open* / surgery
Humans
Leg Injuries*
Lower Extremity / injuries
Plastics
Retrospective Studies
Soft Tissue Injuries* / surgery
Tibial Fractures* / surgery
Treatment Outcome

Substances

Plastics