Orthoplastic Limb Salvage Centers: A Survey to Determine Essential Components and Framework for Implementation

Area of Science:

• Orthoplastic surgery
• Limb salvage surgery
• Healthcare management

Background:

• Limb-threatening pathology management is challenging.
• Orthoplastic limb salvage centers aim to improve care for complex extremity conditions.
• Formal criteria for establishing these centers are lacking.

Purpose of the Study:

• To survey existing orthoplastic limb salvage centers.
• To assess current practices and identify recommended characteristics.
• To establish consensus-based criteria for center development.

Main Methods:

• Survey of orthoplastic limb salvage centers within the American Society of Reconstructive Microsurgery membership in the US.
• Evaluation of team structure, outcome tracking, quality systems, and implementation barriers.
• Calculation of consensus rates for current and recommended practices.

Main Results:

• Consensus on essential criteria: multidisciplinary teams (100%), high case volume (96%), 24/7 availability (87%), standardized outcome tracking (83%).
• Strong agreement on specialist integration (vascular surgery, infectious disease, physiatry).
• Identified implementation gaps in dedicated OR time and standardized outcome measurement; key barriers include lack of standardized reporting, institutional support, and funding.

Conclusions:

• A consensus-based framework for developing orthoplastic limb salvage centers is provided.
• Comprehensive multidisciplinary care, outcome metrics, and quality systems require standardization.
• Barriers to quality initiatives include lack of universal standards, institutional support, and financial constraints.