Interdisciplinary Plastic Surgery - Chances, Conditions and Barriers of Reconstructive Microsurgery in Maximum Care Hospitals

Abstract

The introduction of free tissue transfers has revolutionized reconstructive purposes. This is particularly important after extensive traumas, profound infections and tumor resections. Nevertheless, independent plastic surgery centers are not available at 11 of 35 university hospitals in Germany. The purpose of this study was to demonstrate the importance of reconstructive microsurgery at a university hospital in interdisciplinary cooperation on the basis of cases treated in one year. In 2018, 47 patients at one site underwent 50 microvascular free flap reconstructions. The data were retrospectively screened for patients' demographics, comorbidities, perioperative and postoperative details, interdisciplinary context, hospitalization, complications, and final outcomes. Fifty free tissue flap transfers were performed after complex traumas (23.4 %), infections (25.5 %), tumor resections (42.6 %), PAD (4.2 %) and secondary lymphoedema (4.2 %). In 76.6 % of the patients, microsurgical reconstruction was performed in interdisciplinary cooperation (trauma surgery: 19.1 %, neurosurgery: 19.1 %, thoracic surgery: 4.3 %, heart surgery: 2.1 %, vascular surgery: 2.1 %, orthopedics: 25.5 %, internal medicine: 4.3 %), with 89.2 % involving at least two different departments. Postoperatively, 43.2 % of the free flaps were treated on a non-plastic surgical ward. Reconstructive plastic surgery is of central importance in the treatment of complex surgical defect reconstructions after tumor resections, infections or traumas. Also plastic surgery contributes substantially to the treatment of complications occurring in other specialties. For those reasons, an independent and adequately staffed department of plastic surgery should be available at all clinics of maximum care, especially at all 35 university hospitals in Germany. As this is currently not the standard of care in Germany, changes are required.