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

Abstract

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.

Evaluation of bone length and number of osteotomies utilizing the osteocutaneous radial forearm free flap for mandible reconstruction: An 8‐year review of complications and flap survival

“…2 Several studies have since examined the effect of prophylactic plating and demonstrated a significant reduction in the prevalence of pathologic radial fractures. [3][4][5]7,21 Despite the effectiveness of prophylactic plating, a cost-effective analysis published by Rockwell and Thoma 22 determined that prophylactic plating of the donor radius is not a costeffective method when compared to treatment of donor radius fractures after they occur. Additionally, prophylactic plating with simultaneous iliac crest bone grafting has more recently been described.…”

The use of the Radial Styloid in the Extended Osteocutaneous Radial Forearm Free Flap

“…Placing a plate on the donor radius is not simple or risk free (4). It adds time, complexity and cost to a procedure, which inherently consume a great deal of resources and this may not be cost effective (30). However, when a fracture occurs with fixation in place, treatment is less difficult because the fractures tend not to displace (4,5,10,27).…”

Mandibular reconstruction

“…Sixth, it is important to exclude arteria peronea magna directly before harvest of the peroneal vessels; this is performed by inspecting the peroneal vessels for excessive size and by placing a microvascular clamp across the distal peroneal vessels early in the flap harvest to ensure maintenance of pedal pulses and absence of foot ischaemia. 30,31 The scapula donor site provides versatility regarding the soft tissue reconstruction, but the quality of the donor bone does not approach that of the fibula, and its location on the back is a major drawback since it precludes a two-team approach, prolonging the operation. Other reported donor site morbidities from fibula harvest are also generally avoidable.…”