Towards performance measurement in reconstructive surgery: A multicentre pilot study of free and pedicled flap procedures


Cole, RP; Browne, JP; (2006) Towards performance measurement in reconstructive surgery: A multicentre pilot study of free and pedicled flap procedures. Journal of plastic, reconstructive & aesthetic surgery, 59 (3). pp. 257-262. ISSN 1748-6815 DOI: https://doi.org/10.1016/j.bjps.2005.06.006

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Abstract

Objectives: To pilot the acceptability and feasibility of clinical audit in free and pedicled flap reconstruction. To establish a baseline flap failure rate in participating units, so that a sample size calculation could be performed for future national. audit. Methods: A proforma was piloted over a 3-month period in four participating units, during which time data on 93 reconstructive procedures involving free and pedicled flaps was collected. The patients included those where large transfers of tissue were required such as for coverage of grade IIIb compound tibia( fractures and breast reconstruction after mastectomy, and also smaller flap transfers such as after skin cancer excision. Results: The proforma was found to be acceptable to clinicians and the feasibility of the data collection process was established. Overall there was a total flap survival of 89% and secondary operations to the donor or recipient sites were required in 11% of patients. Conclusions: This study demonstrates the feasibility of comparative audit for free and pedicled flap procedures using the methods proposed. Based on the incidence of flap failure observed in this pilot study, at least 18 months of prospective data collection on consecutive patients is required to fulfil the statistical requirements of comparative audit. The establishment of a routinely collected minimum dataset is proposed as one means of meeting these requirements. (C) 2005 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved.

Item Type: Article
Keywords: plastic surgery, reconstruction, free flap, pedicled flap, quality of, care, FREE-TISSUE TRANSFER, FAILED FREE FLAPS, BREAST RECONSTRUCTION, NECK, HEAD, COMPLICATIONS, EXTREMITIES, SMOKING, CHARTS, Adolescent, Adult, Aged, Aged, 80 and over, Child, Feasibility Studies, Female, Graft Survival, Humans, Length of Stay, Male, Medical Audit, Middle Aged, Pilot Projects, Prospective Studies, Risk Factors, Surgical Flaps, standards
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 16673538
Web of Science ID: 237218300009
URI: http://researchonline.lshtm.ac.uk/id/eprint/6349

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