Cost-effectiveness of a topically applied pre-operative tissue expansion device for radial forearm free flaps: a cohort study.

Abstract

OBJECTIVES:

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.

DESIGN:

A cohort study consisting of patients previously randomised in a randomised controlled trial. An intention to treat design was utilised.

SETTING:

A large tertiary care centre in eastern Ontario, Canada.

PATIENTS:

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.

INTERVENTIONS:

Patients were randomised to either the treatment (pre-operative tissue expansion, DynaClose Expansion System) or control group.

MAIN OUTCOME MEASURES:

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: J P Bonaparte, M Corsten, M Allen
• Journal: Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery (Clin Otolaryngol) Vol. 36 Issue 4 Pg. 345-51 (Aug 2011) ISSN: 1749-4486 [Electronic] England
• PMID: 21651729 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: © 2011 Blackwell Publishing Ltd.

Topics

• Cost-Benefit Analysis
• Female
• Follow-Up Studies
• Forearm (surgery)
• Forearm Injuries (surgery)
• Free Tissue Flaps
• Humans
• Male
• Middle Aged
• Preoperative Care (economics, methods)
• Skin Transplantation (methods)
• Tissue Expansion (economics, instrumentation)
• Tissue Expansion Devices (economics)
• Treatment Outcome
• Wound Healing