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Orthoplastic Limb Salvage Centers: A Survey To Determine Essential Components And Framework For Implementation
Omar Moussa, MD, Seamus P. Caragher, MD, Floris R. Raasveld, MD, Kamilcan Oflazoglu, MD, PhD, Derek Stenquist, MD, Ahmed A. Haleem, MD, PhD, Ian L. Valerio, MD MS MBA FACS, Krystle R. Tuaņo, MD, Kyle R. Eberlin, MD.
MGH/Harvard, BOSTON, MA, USA.
PURPOSE: Management of limb-threatening pathology presents a significant clinical challenge. Orthoplastic limb salvage centers have been developed to streamline care and improve outcomes for complex extremity cases. However, no formal criteria exist for establishing such centers. We conducted a survey of orthoplastic limb salvage centers to assess current practices and develop consensus-based criteria for their establishment.
Methods: Members of the American Society of Reconstructive Microsurgery self-identifying as part of orthoplastic limb salvage centers in the United States were surveyed. We evaluated current practices and recommended characteristics regarding team structure, outcome tracking, quality systems, and barriers to standard implementation. Consensus rates (%) were calculated for current versus recommended practices to demonstrate implementation gaps.
Results: Strong consensus was achieved for four criteria: multidisciplinary orthoplastic teams (100%), high case volume (96%), 24/7 service availability (87%), and standardized outcome tracking (83%). Specialist integration showed strong agreement for vascular surgery, infectious disease, and physiatry (83% each). Gaps remained in dedicated OR time (48% current vs. 65% recommended) and outcome measurement (52% vs. 65%). Primary barriers included lack of standardized outcome reporting (83%), limited institutional support (70%), and financial constraints (61%).
Conclusion: This study defines essential criteria for orthoplastic limb salvage centers. National survey findings highlight multidisciplinary care, outcome tracking, and quality systems as priorities for standardization, while universal standards, institutional support, and financial limitations remain key barriers.
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