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2.
Aesthetic Plast Surg ; 40(6): 901-907, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27699461

RESUMEN

BACKGROUND: INTEGRA® Dermal Regeneration Template is a well-known and widely used acellular dermal matrix. Although it helps to solve many challenging problems in reconstructive surgery, the product cost may make it an expensive alternative compared to other reconstruction procedures. This retrospective study aims at comparing INTEGRA-based treatment to flap surgery in terms of cost and benefit. PATIENTS AND METHODS: We considered only patients treated for scalp defects with bone exposure in order to obtain two groups as homogeneous as possible. We identified two groups of patients: 17 patients treated with INTEGRA and 18 patients treated with flaps. All patients were admitted in our institution between 2004 and 2010, and presented a defect of the scalp following trauma or surgery for cancer, causing a loss of the soft tissues of the scalp with bone exposure without pericranium. To calculate the cost in constant euros of each treatment, three parameters were evaluated for each patient: cost of the surgical procedure (number of doctors and nurses involved, surgery duration, anesthesia, material used for surgery), hospitalization cost (hospitalization duration, dressings, drugs, topical agents), and outpatient cost (number of dressing changes, personnel cost, dressings type, anti-infective agents). The statistical test used in this study was the Wilcoxon Mann-Whitney (α = 0.05). RESULTS: No significant difference was characterized between the two groups for gender, age, presence of diabetes, mean defect size, and number of surgical procedures. All patients healed with good quality and durable closure. The median total cost per patient was €11,121 (interquartile range (IQR) 8327-15,571) for the INTEGRA group and €7259 (IQR 1852-24,443) for the flap group (p = 0.34). A subgroup of patients (six patients in the INTEGRA group and five patients in the flap group) showing defects larger than 100 cm2 were considered in a second analysis. Median total cost was €11,825 (IQR 10,695-15,751) for the INTEGRA group and €23,244 (IQR 17,348-26,942) for the flap group. CONCLUSION: Both treatments led to a good healing of the lesions with formation of soft and resistant tissue. No significant difference was characterized between the two groups for days of hospitalization and costs. In cases of patients with defects larger than 100 cm2 for whom major surgery is needed, the treatment with INTEGRA seemed to be less expensive than the treatment with free flaps or pedicle flaps. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A5 online Instructions to Authors. www.springer.com/00266 .


Asunto(s)
Sulfatos de Condroitina/economía , Colágeno/economía , Colgajos Tisulares Libres/economía , Colgajos Tisulares Libres/trasplante , Procedimientos de Cirugía Plástica/métodos , Cuero Cabelludo/cirugía , Trasplante de Piel/métodos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Análisis Costo-Beneficio , Femenino , Estudios de Seguimiento , Costos de Hospital , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Procedimientos de Cirugía Plástica/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Cuero Cabelludo/lesiones , Trasplante de Piel/economía , Cráneo/lesiones , Cráneo/cirugía , Resultado del Tratamiento , Cicatrización de Heridas/fisiología
3.
Chir Main ; 29(2): 109-13, 2010 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-20188619

RESUMEN

We report three cases of complete rupture of the flexor pollicis longus (FPL) tendon, one case of complete rupture of the index and middle finger flexor digitorum profundus tendons and one case of rupture of the flexor digitorum profundus tendon to the index finger after placement of a volar plate for distal radius fracture. We review the literature and discuss the aetiology of tendon ruptures and techniques to prevent tendon attition.


Asunto(s)
Placas Óseas/efectos adversos , Dedos , Fijación Interna de Fracturas/efectos adversos , Fracturas del Radio/cirugía , Traumatismos de los Tendones/etiología , Adulto , Anciano de 80 o más Años , Causalidad , Remoción de Dispositivos , Diseño de Equipo , Falla de Equipo , Femenino , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Fuerza de la Mano , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/etiología , Rango del Movimiento Articular , Rotura , Traumatismos de los Tendones/diagnóstico por imagen , Traumatismos de los Tendones/cirugía , Tendones/trasplante
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