Bilaminate Synthetic Dermal Matrix versus Free Fascial Flaps: A Cost-Effectiveness Analysis for Full-Thickness Hand...

Area of Science:

• Orthopedic Surgery
• Microsurgery
• Regenerative Medicine

Background:

• Full-thickness hand injuries necessitate durable soft tissue coverage for optimal function.
• Preserving tendon gliding and hand motion is crucial after severe hand trauma.
• Comparing reconstruction techniques is vital for effective patient care.

Purpose of the Study:

• To evaluate the cost-effectiveness of free fascial flap reconstruction versus bilaminate synthetic dermal matrices for hand resurfacing.
• To determine the most economically viable option for complex hand wound coverage.

Main Methods:

• Decision tree analysis with rollback method to model cost-effectiveness.
• Systematic literature review to establish total active range of motion as the outcome.
• Payer perspective costing using Medicare reimbursements and worker's compensation thresholds.
• Probabilistic sensitivity analysis with 10,000 Monte Carlo simulations.

Main Results:

• Free fascial flap reconstruction averaged $14,201.24, while synthetic dermal matrices averaged $13,674.20.
• Free fascial flaps provided an incremental 18.0 degrees of motion at a cost-effectiveness ratio of $29.30/degree.
• Microsurgical reconstruction was economically sound in 57.5% of simulated scenarios.

Conclusions:

• Free fascial flap reconstruction offers marginally better outcomes at a slightly higher cost than synthetic dermal matrices.
• Both reconstruction methods are cost-effective for complex hand wounds.
• Neither technique presents a clear economic advantage, suggesting patient-specific factors may guide selection.