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Research Article
Dimitra Kotsougiani-Fischer
Berufsgenossenschaftliche Unfallklinik Ludwigshafen
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
BACKGROUND
This study aimed to assess a multidisciplinary team (MDT) meeting approach for the management of patients with complex extremity defects, analyze treatment recommendations, and evaluate factors influencing non-implementation.
METHODS
All patients introduced to an MDT meeting for complex extremity defects from 2015 to 2017 were included. Patients’ characteristics and defect causes were evaluated. Treatment recommendations of MDT meetings and subsequent implementation were reviewed, and factors associated with non-adherence to recommendations were statistically analyzed using logistic regression.
RESULTS
Fifty-one patients (41 male) with a mean age of 54 years were presented in 27 MDT meetings. Most of the patients (70%) suffered from reconstructive challenging or combined bone- and soft tissue defects, primarily located at the lower extremity (88%). Large skeletal defects, chronic osteomyelitis, and multi-fragmented fractures were present in 65% of cases. Forty-five percent of the patients suffered from peripheral vascular disease, necessitating surgical optimization. Of the 51 MDT decisions, 40 were implemented (78%; (32/40) limb salvage versus 22%; (8/40) limb amputation). Limb salvage was successfully achieved in 91% (29/32) of the cases. Failed limb salvages were due to flap failure (33%; 1/3), recurring periprosthetic joint infections (66%; 2/3) and concomitant reconstructive failure. Patients who underwent limb amputation, as recommended, showed proper stump healing and regained mobility with a prosthesis. Overall the MDT treatment plan was effective in 92.5% (37/40) of the patients, who adhered to the MDT treatment recommendation. In eleven patients (22%; 11/51), the MDT treatment was not implemented. MDT decisions were less likely to be implemented, if amputation was recommended (p = 0.029.
CONCLUSIONS
MDT meetings represent a valid tool to formulate individualized treatment plans, avoiding limb amputation in most patients with severe extremity defects. Recommendation for limb amputation is less likely to be implemented than plans for limb salvage.
TRIAL REGISTRATION:
Retrospectively registered
Keywords
multidisciplinary team meetings, complex extremity defects, free flap, bone reconstruction
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CURRENT STATUS: Published
View the published article at BMC Surgery.
Version 1
Posted 28 Dec, 2020
No community comments so far
Editorial decision: Major revision
On 11 Jan, 2021
Reviews received
Received 07 Jan, 2021
Reviewers agreed
On 30 Dec, 2020
Reviewers invited
Invitations sent on 30 Dec, 2020
Editor assigned
On 28 Dec, 2020
Editor invited
On 24 Dec, 2020
Submission checks complete
On 24 Dec, 2020
First submitted
On 10 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Surgery.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Dimitra Kotsougiani-Fischer
Berufsgenossenschaftliche Unfallklinik Ludwigshafen
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Surgery.
Version 1
Posted 28 Dec, 2020
No community comments so far
Editorial decision: Major revision
On 11 Jan, 2021
Reviews received
Received 07 Jan, 2021
Reviewers agreed
On 30 Dec, 2020
Reviewers invited
Invitations sent on 30 Dec, 2020
Editor assigned
On 28 Dec, 2020
Editor invited
On 24 Dec, 2020
Submission checks complete
On 24 Dec, 2020
First submitted
On 10 Dec, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Surgery.
BACKGROUND
This study aimed to assess a multidisciplinary team (MDT) meeting approach for the management of patients with complex extremity defects, analyze treatment recommendations, and evaluate factors influencing non-implementation.
METHODS
All patients introduced to an MDT meeting for complex extremity defects from 2015 to 2017 were included. Patients’ characteristics and defect causes were evaluated. Treatment recommendations of MDT meetings and subsequent implementation were reviewed, and factors associated with non-adherence to recommendations were statistically analyzed using logistic regression.
RESULTS
Fifty-one patients (41 male) with a mean age of 54 years were presented in 27 MDT meetings. Most of the patients (70%) suffered from reconstructive challenging or combined bone- and soft tissue defects, primarily located at the lower extremity (88%). Large skeletal defects, chronic osteomyelitis, and multi-fragmented fractures were present in 65% of cases. Forty-five percent of the patients suffered from peripheral vascular disease, necessitating surgical optimization. Of the 51 MDT decisions, 40 were implemented (78%; (32/40) limb salvage versus 22%; (8/40) limb amputation). Limb salvage was successfully achieved in 91% (29/32) of the cases. Failed limb salvages were due to flap failure (33%; 1/3), recurring periprosthetic joint infections (66%; 2/3) and concomitant reconstructive failure. Patients who underwent limb amputation, as recommended, showed proper stump healing and regained mobility with a prosthesis. Overall the MDT treatment plan was effective in 92.5% (37/40) of the patients, who adhered to the MDT treatment recommendation. In eleven patients (22%; 11/51), the MDT treatment was not implemented. MDT decisions were less likely to be implemented, if amputation was recommended (p = 0.029.
CONCLUSIONS
MDT meetings represent a valid tool to formulate individualized treatment plans, avoiding limb amputation in most patients with severe extremity defects. Recommendation for limb amputation is less likely to be implemented than plans for limb salvage.
TRIAL REGISTRATION:
Retrospectively registered
Figure 1
Figure 2
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