PDF herunterladen
J Reconstr Microsurg 2004; 20(4): 297-306
DOI: 10.1055/s-2004-824887
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Should the Donor Radius be Plated Prophylactically after Harvest of a Radial Osteocutaneous Flap? A Cost-Effectiveness Analysis

Gloria M. Rockwell1 , Achilleas Thoma2
  • 1Division of Plastic and Reconstructive Surgery, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario
  • 2Department of Surgery, Division of Plastic and Reconstructive Surgery, St. Joseph's Healthcare, Surgical Outcomes Research Centre (SOURCE) and McMaster University, Hamilton, Ontario
Weitere Informationen

Publikationsverlauf

Accepted: 25 November 2003

Publikationsdatum:
19. April 2004 (online)

Auch verfügbar auf
    Lizenzen und Reprints

The objective of this study was to assess the cost-effectiveness of prophylactic plating of the donor radius after harvest of a radial osteocutaneous flap. Costs were measured from a Ministry of Health perspective, and effectiveness in terms of quality adjusted life years (QALYs.) A literature search identified 22 studies reporting complications of radial osteocutaneous free flaps, and nine studies reporting complications of radius plating. The rates of the various complications were pooled to provide the probability of each clinically important complication. A decision analytic model was used to determine the total costs, and QALYs for each of the treatment options. The expected direct costs for prophylactic plating and treatment after fracture were $2071 and $140, respectively. The expected QALYs for prophylactic plating and treatment after fracture were 8.55 and 9.92, respectively. It was concluded that prophylactic plating of the donor radius is not a cost-effective approach when compared to the treatment of donor radius fractures after they occur.

KEYWORDS

Radial forearm osteocutaneous flap - fracture - prophylactic plating - cost-effectiveness analysis - economic evaluation

REFERENCES

  • 1 Schusterman M A, Miller M J, Reece G P, Kroll S S, Marchi M, Goepfert H. A single center's experience with 308 free flaps for repair of head and neck cancer defects.  Plast Reconstr Surg. 1994;  93 472-478 , discussion 479-480
    CrossrefPubMedSuche in Google Scholar
  • 2 Urken M L. Composite free flaps in oromandibular reconstruction.  Arch Otolaryngol Head Neck Surg. 1991;  117 724-732
    CrossrefPubMedSuche in Google Scholar
  • 3 Zenn M R, Hidalgo D A, Cordeiro P G, Shah J P, Strong E W, Kraus D H. Current role of the radial forearm free flap in mandibular reconstruction.  Plast. Reconstr. Surg. 1997;  99 1012-1017
    CrossrefPubMedSuche in Google Scholar
  • 4 Muldowney J B, Cohen J I, Porto D P, Maisel R H. Oral cavity reconstruction using the free radial forearm flap.  Arch Otolarnygol Head Neck Surg. 1987;  113 1219-1224
    PubMedSuche in Google Scholar
  • 5 Coleman 3rd J J, Wooden W A. Mandibular reconstruction with composite microvascular tissue transfer.  Am J Surg. 1990;  160 390-395
    PubMedSuche in Google Scholar
  • 6 Talesnik A, Markowitz B, Calcaterra T, Ahn C, Shaw W. Cost and outcome of osteocutaneous free-tissue transfer versus pedicled soft-tissue reconstruction for composite mandibular defects.  Plast Roconstr Surg. 1996;  97 1167-1178
    PubMedSuche in Google Scholar
  • 7 Matthews R N, Fatah F, Davies D M, Eyre J, Hodge R A, Walsh-Waring G P. Experience with the radial forearm flap in 14 cases.  Scand J Plast Reconstr Surg. 1984;  18 303-310
    CrossrefPubMedSuche in Google Scholar
  • 8 Boorman J G, Brown J A, Sykes P J. Morbidity in the forearm flap donor arm.  Br J Plast Surg. 1987;  40 207-212
    CrossrefPubMedSuche in Google Scholar
  • 9 Bardsley A F, Soutar D S, Elliot D, Batchelor A G. Reducing morbidity in the radial forearm flap donor site.  Plast Reconstr Surg. 1990;  86 287-292 , discussion 293-294
    CrossrefPubMedSuche in Google Scholar
  • 10 Inglefield C J, Kolhe P S. Fracture of the radial forearm osteocutaneous donor site.  Ann Plast Surg. 1994;  33 638-642 , discussion 643
    PubMedSuche in Google Scholar
  • 11 Smith A A, Bowen C V, Rabczak T, Boyd J B. Donor site deficit of the osteocutaneous radial forearm flap.  Ann Plast Surg. 1994;  32(4) 372-376
    PubMedSuche in Google Scholar
  • 12 Evans G R, Schusterman M A, Kroll S S et al.. The radial forearm free flap for head and neck reconstruction: a review.  Am J Surg. 1994;  168 446-450
    CrossrefPubMedSuche in Google Scholar
  • 13 Boyd J B, Rosen I, Rotstein L, et a l. The iliac crest and the radial forearm flap in vascularized oromandibular reconstruction.  Am J Surg. 1990;  159 301-308
    CrossrefPubMedSuche in Google Scholar
  • 14 Bowers K W, Edmonds J L, Girod D A, Jayaraman G, Chua C P, Toby E B. Osteocutaneous radial forearm free flaps: the necessity of internal fixation of the donor-site defect to prevent pathological fracture.  J Bone Joint Surg Am. 2000;  82 694-704
    CrossrefPubMedSuche in Google Scholar
  • 15 Thoma A, Khadaroo R, Grigenas O, et a l. Oromandibular reconstruction with the radial forearm osteocutaneous flap: experience with 60 consecutive cases.  Plast Reconstr Surg. 1999;  104 368-378 , discussion 379-380
    CrossrefPubMedSuche in Google Scholar
  • 16 Thoma A. Letter to Editor.  Plast Reconst Surg. 2000;  105 1901
    PubMedSuche in Google Scholar
  • 17 Thoma A. Letter to Editor.  Plast Reconstr Surg. 2000;  106 1425
    PubMedSuche in Google Scholar
  • 18 Langkamer V G, Ackroyd C E. Removal of forearm plates: a review of the complications.  J Bone Joint Surg Br. 1990;  72 601-604
    CrossrefPubMedSuche in Google Scholar
  • 19 Bednar D A, Grandwilewski W. Complications of forearm-plate removal.  Can J Surg. 1992;  35 428-431
    PubMedSuche in Google Scholar
  • 20 Chapman M W, Gordon J E, Zissimos A G. Compression-plate fixation of acute fractures of the diaphysis of the radius and ulna.  J Bone Joint Surg Am. 1989;  71 159-169
    PubMedSuche in Google Scholar
  • 21 Anderson L D, Sisk D, Tooms R E, Park III W I. Compression-plate fixation in acute diaphyseal fractures of the radius and ulna.  J Bone Joint Surg Am. 1975;  57 287-297
    PubMedSuche in Google Scholar
  • 22 Dodge H S, Cady G W. Treatment of fractures of the radius and ulna with compression plates: a retrospective study of one hundred and nineteen fractures in seventy-eight patients.  J Bone Joint Surg Am. 1972;  54 1167-1176
    PubMedSuche in Google Scholar
  • 23 Boyd J B, Mulholland R S, Davidson J et al.. The free flap and plate in oromandibular reconstruction: long-term review and indications.  Plast Reconstr Surg. 1995;  95 1018-1028
    CrossrefPubMedSuche in Google Scholar
  • 24 Wells M D. Part I. Mandibular reconstruction using vascularized bone grafts.  J Oral Maxillofac Surg. 1996;  4 883-888
    PubMedSuche in Google Scholar
  • 25 Weinzweig N, Jones N F, Shestak K C, Moon H K, Davies B W. Oromandibular reconstruction using a keel-shaped modification of the radial forearm osteocutaneous flap.  Ann Plast Surg. 1994;  33 359-369 , discussion 369-370
    CrossrefPubMedSuche in Google Scholar
  • 26 Thoma A, Allen M, Tadeson B H, Archibald S, Jackson S, Young J E. The fate of the osteotomized free radial forearm osteocutaneous flap in mandible reconstruction.  J Reconstr Microsurg. 1995;  1 215-219
    PubMedSuche in Google Scholar
  • 27 Swanson E, Boyd J B, Manktelow R T. The radial forearm flap: reconstructive applications and donor-site defects in 35 consecutive patients.  Plast Reconstr Surg. 1990;  85 258-266
    CrossrefPubMedSuche in Google Scholar
  • 28 Davidson J, Boyd B, Gullane P et al.. A comparison of the results following oromandibular reconstruction using a radial forearm flap with either radial bone or a reconstruction plate.  Plast Reconstr Surg. 1991;  88 201-208
    PubMedSuche in Google Scholar
  • 29 Nakatsuka T, Harii K, Yamada A, Ueda K, Ebihara S. Dual free flap transfer using forearm flap for mandibular reconstruction.  Head Neck Surg. 1992;  14 452-458
    CrossrefPubMedSuche in Google Scholar
  • 30 Laupacis A, Feeny D, Detsky A S, Tugwell P X. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations.  Can Med Assoc J. 1992;  146 473-481
    PubMedSuche in Google Scholar
  • 31 Gafni A, Birch S. Guidelines for the adoption of new technologies: a prescription for uncontrolled growth in expenditures and how to avoid the problem.  Can Med Assoc J. 1993;  148 913-917
    PubMedSuche in Google Scholar
  • 32 Detsky A S, Naglie I G. A clinician's guide to cost-effectiveness analysis.  Ann Int Med. 1990;  113 147-154
    PubMedSuche in Google Scholar
  • 33 Udvarhelyi I S, Colditz G A, Rai A, Epstein A M. Cost-effectiveness and cost-benefit analysis in the medical literature. Are the methods being used correctly?.  Ann Int Med. 1992;  116 238-244
    PubMedSuche in Google Scholar
  • 34 Weinstein M C, Siegel J E, Gold M R, Kamlet M S, Russell L B. Recommendations of the Panel on Cost-Effectiveness in Health and Medicine.  JAMA. 1996;  276 1253-1258
    CrossrefPubMedSuche in Google Scholar
  • 35 Russell L B, Gold M R, Siegel J E, Daniels N, Weinstein M C. The role of cost-effectiveness analysis in health and medicine.  JAMA. 1996;  276 1172-1177
    CrossrefPubMedSuche in Google Scholar
  • 36 Eisenberg J M. Clinical economics: a guide to the economic analysis of clinical practices.  JAMA. 1989;  262 2879-2886
    CrossrefPubMedSuche in Google Scholar
  • 37 Loomes G, McKenzie L. The use of QALYs in health care decision making.  Soc Sci Med. 1989;  28 299-308
    CrossrefPubMedSuche in Google Scholar
  • 38 Deluca P A, Lindsey R W, Ruwe P A. Re-fractures of bones of the forearm after the removal of compression plates.  J Bone Joint Surg Am. 1988;  70 1372-1376
    PubMedSuche in Google Scholar
  • 39 Hidaka S, Gustilo R B. Refractures of bones of the forearm after plate removal.  J Bone Joint Surg Am. 1984;  66 1241-1243
    PubMedSuche in Google Scholar
  • 40 Rosson J W, Shearer J R. Refracture after the removal of plates from the forearm.  J Bone Joint Surg Br. 1991;  73 415-417
    CrossrefPubMedSuche in Google Scholar
  • 41 Richardson W S, Detsky A S. User's guides to the medical literature: How to use a clinical decision analysis. Are the results of the study valid?.  JAMA. 1995;  273 1292-1295
    CrossrefPubMedSuche in Google Scholar
  • 42 Richardson W S, Detsky A S. User's guides to the medical literature: How to use a clinical decision analysis. What are the results and will they help me in caring for my patients?.  JAMA. 1995;  273 1610-1613
    CrossrefPubMedSuche in Google Scholar
  • 43 Vasen A P, Kuntz K M, Simmons B P, Katz J N. Open versus endoscopic carpal tunnel release: a decision analysis.  J Hand Surg Am. 1999;  24 1109-1117
    CrossrefPubMedSuche in Google Scholar
  • 44 Schedule of Benefits: Physician Services Under the Health Insurance Act. Toronto, Onterio, Canada; Onterio Ministry of Health and Long Term Care 2001
    Suche in Google Scholar
  • 45 Read J L, Quinn R J, Berwick D M, Fineberg H V, Weinstein M C. Preferences for health outcomes: Comparison of assessment methods.  Med Decis Making. 1984;  4 315-329
    CrossrefPubMedSuche in Google Scholar
  • 46 Hornberger J C, Redelmeier D A, Petersen J. Variability among methods to assess patient's well-being and consequent effect on a cost-effectiveness analysis.  J Clin Epidemiol. 1992;  45 505-512
    CrossrefPubMedSuche in Google Scholar
  • 47 Kaplan R M, Bush H. Health-related quality of life measurements for evaluation, research and policy analysis.  Health Psychol. 1982;  1 62
    PubMedSuche in Google Scholar
  • 48 Torrance G W. Measurement of health state utilities for economic appraisal.  J Health Econ. 1986;  5 1-30
    CrossrefPubMedSuche in Google Scholar
  • 49 Weeks J. Measurement of utilities and quality-adjusted survival.  Oncology. 1995;  9(11 Suppl) 67-70
    PubMedSuche in Google Scholar
  • 50 Frame J D, Bradley N, James D R, Stearns M P, Brough M D. Reconstruction of the middle third of mandible.  Br J Plast Surg. 1987;  40 274-277
    CrossrefPubMedSuche in Google Scholar
  • 51 Hentz V R, Pearl R M, Grossman J A, Wood M B, Cooney W P. The radial forearm flap: a versatile source of composite tissue.  Ann Plast Surg. 1987;  19 485-498
    PubMedSuche in Google Scholar
  • 52 O'Brien C J, Archer D J, Breach N M, Shaw H J. Reconstruction of the mandible with autogenous bone following treatment for squameous carcinoma.  Aust N Z J Surg. 1986;  56 707-715
    PubMedSuche in Google Scholar
  • 53 Soutar D S, Widdowson W P. Immediate reconstruction of the mandible using a vascularized segment of radius.  Head Neck Surg. 1986;  8 232-346
    PubMedSuche in Google Scholar
  • 54 Vaughan E D. The radial forearm free flap in orofacial reconstruction: personal experience in 120 consecutive cases.  J Craniomaxillofac Surg. 1990;  18 2-7
    CrossrefPubMedSuche in Google Scholar
  • 55 Evans H B, Lampe H B. The radial forearm flap in head and neck reconstruction.  J Otolaryngol. 1987;  16 382-386
    PubMedSuche in Google Scholar
  • 56 Muller M E, Allgower M, Schneider R, Willenegger H. Manual of Internal Fixation: Techniques Recommended by the AO Group, 2nd ed. Berlin; Springer-Verlag 1979
    Suche in Google Scholar
  • 57 Wagstaff A. QALYs and the equity-efficiency trade-off.  J Health Econ. 1991;  10 21-41 , Erratum in: J Health Econ 1993;12:237
    CrossrefPubMedSuche in Google Scholar

Achilleas ThomaM.D. M.Sc. F.R.C.S.C. 

206 James Street South, Suite 101

Hamilton, Ontario

L8P 3A9, Canada