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Cost‐effectiveness of a topically applied pre‐operative tissue expansion device for radial forearm free flaps: a cohort study 1
Author(s) -
Bonaparte J.P.,
Corsten M.,
Allen M.
Publication year - 2011
Publication title -
clinical otolaryngology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.914
H-Index - 68
eISSN - 1749-4486
pISSN - 1749-4478
DOI - 10.1111/j.1749-4486.2011.02354.x
Subject(s) - medicine , randomized controlled trial , cohort , forearm , tissue expansion , surgery , otorhinolaryngology , cohort study , physical therapy
Clin. Otolaryngol. 2011, 36 , 345–351 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.