COMPARISON BETWEEN SINGLE STAGE AND STAGED MULTIFOCAL PROCEDURES IN LIMB RECONSTRUCTION SURGERY

Abstract

As the number of patients being offered multifocal procedures in limb reconstruction surgery has increased a study was performed to compare single stage and staged procedures.

A retrospective analysis of all multifocal procedures (more than two sites) performed between 1988 and 1997 was carried out looking at treatment times, results and complication rates. A total of 51 multifocal procedures were performed. The mean number of sites operated on was 3.8 per patient for single stage and 4 per patient for staged. There were 18 single stage and 33 staged operations. There were 29 performed on the paediatric age group for indications such as achondroplasia and short stature. The rest were in adults where the main indications were related to complex trauma management and their complications. External Fixation was the principle method of treatment.

The total hospital stay averaged 18 days for single stage procedures and 29 days for staged. Of the single stage cases 12 had one operation with a mean of 1.33 operations (including surgery for complications) compared to staged procedures which had an average of 2.8 operations (range 2–5 ). In addition, the total treatment time (time of first surgery to discharge) was more for staged surgery, 5 years compared to 3.6 years. In the single stage group 9 patients (50%) had at least one significant post operative complication (2 severe, 7 moderate) and in the staged group 19 (57%) had significant complications (3 severe, 16 moderate). There was no detectable difference in the final clinical result obtained between the groups.

From this study we would conclude that single stage procedures carry no increased risk and are of benefit to patients because of the shorter hospitalisation, reduction in the number of operations and general anaesthetics and the reduced time to final outcome.