Background: Radical resection of pelvic and low rectal malignancies leads to complex reconstructive challenges. Many pelvic reconstruction options have been described including primary closure, omental flaps, and various fasciocutaneous and myocutaneous flaps. Little consensus exists in the literature on which of the various options in the reconstructive armamentarium provides a superior outcome. The authors of this study set out to determine the costs and quality-of-life outcomes of primary closure, vertical rectus abdominus muscle flap, gluteal thigh flap, and gracilis flap to aid surgeons in identifying an optimal reconstructive algorithm.

Methods: A decision tree analysis was performed to analyze the cost, complications, and quality-of-life associated with reconstruction by primary closure, gluteal thigh flap, vertical rectus abdominus muscle flap, and gracilis flap. Costs were derived from Medicare reimbursement rates (FY2021), while quality-adjusted life-years were obtained from the literature.

Results: Gluteal thigh flap was the most cost-effective treatment strategy with an overall cost of $62,078.28 with 6.54 quality-adjusted life-years and an incremental cost-effectiveness ratio of $5,649.43. Gluteal thigh flap was always favored as the most cost-effective treatment strategy in our 1-way sensitivity analysis. Gracilis flap became more cost-effective than gluteal thigh flap, in the scenario where gluteal thigh flap complication rates increased by roughly 4% higher than gracilis flap complication rates.

Conclusion: Our data suggest that, when available, gluteal thigh flap be the first-line option for reconstruction of pelvic defects as it provides the best quality-of-life at the most cost-effective price point. However, future studies directly comparing outcomes of gluteal thigh flap to vertical rectus abdominus muscle and gracilis flap are needed to further delineate superiority.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.surg.2022.09.015DOI Listing

Publication Analysis

Top Keywords

gluteal thigh
32
thigh flap
32
gracilis flap
20
flap
14
primary closure
12
vertical rectus
12
rectus abdominus
12
abdominus muscle
8
gluteal
8
thigh
8

Similar Publications

Sotrovimab is a recombinant human monoclonal antibody for the early treatment of mild-to-moderate COVID- 19. A phase I, open-label, randomized, parallel-group study was conducted to investigate the pharmacokinetics, relative bioavailability, safety, and tolerability of two concentrations of sotrovimab administered intramuscularly at different injection sites in healthy volunteers. The study consisted of three parts (A, B, and C) and the pharmacokinetic results from Part A are reported herein.

View Article and Find Full Text PDF

Herpes zoster (HZ), caused by the reactivation of the varicella-zoster virus (VZV), typically presents as a unilateral vesicular rash in a dermatomal pattern. Its occurrence in the genital area is rare and often misdiagnosed. We report the case of a 51-year-old woman who presented with sudden vulvar pain and burning, without a history of immunodeficiency or sexually transmitted infections.

View Article and Find Full Text PDF

Surgical site infections after sarcoma resections in the peripelvic region: do we need perioperative antibiotic prophylaxis?

Front Oncol

October 2024

Orthopaedic Oncology, Department of Orthopaedics and Trauma Surgery, Ludwig-Maximilian-University (LMU) University Hospital, Ludwig-Maximilian-University (LMU) Munich, Munich, Germany.

Introduction: Surgical site infections (SSI) are one of the most common complications after extensive sarcoma resections and represent a daily challenge. SSI occur in up to 50% of cases particularly in the peripelvic area. One possible approach to reduce infection rate is perioperative antibiotic prophylaxis.

View Article and Find Full Text PDF
Article Synopsis
  • - Cabotegravir, used for HIV treatment and prevention via intramuscular injection, is being evaluated for thigh muscle as an alternative injection site compared to the traditional gluteal site, with a focus on its pharmacokinetics and demographic impacts.
  • - In a study involving both HIV-negative and HIV-positive participants, researchers collected and analyzed cabotegravir concentration data from thigh and gluteal injections, finding significant differences in absorption rates based on sex and body mass index (BMI).
  • - The analysis indicates that while thigh injections have a slower absorption rate and slightly lower bioavailability compared to gluteal injections, the results provide important insights for optimizing dosing strategies and future research on cabotegravir use.
View Article and Find Full Text PDF
Article Synopsis
  • - The study explores how leg dominance affects the choice of perforator flap donor sites for reconstruction surgeries using advanced imaging techniques to enhance preoperative planning.
  • - In a sample of 40 patients, most (87.5%) were right-leg dominant, showcasing that the dominant leg typically has larger and more numerous perforators for certain flap types compared to the nondominant leg.
  • - Results suggest that surgeons may benefit from prioritizing the dominant leg as a donor site, as it has better vascular characteristics and muscle thickness for improving surgical outcomes, although no significant differences were found in the subcutaneous tissue thickness.
View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!