Hamilton, Ontario, Canada From the Departments of Surgery and Clinical Epidemiology and Biostatistics and the Michael G. DeGroote School of Medicine, McMaster University.
Plast Reconstr Surg. 2009 Dec;124(6 Suppl):e303-e312. doi: 10.1097/PRS.0b013e3181bf8283.
The reporting of microsurgical outcomes has been variable. Historically, emphasis has been placed on flap and digit survival or failure in the case of free-tissue transfer or digit replantation, respectively. Outcomes have also been measured with indices such as range of motion or grip strength for digital replantations, the ability to eat or talk for head and neck microsurgery, and the ability to walk or return to work for lower extremity microsurgery. Although relevant, this type of reporting of outcomes may fail to capture the effectiveness of microsurgical intervention from the patient's, the third-party payer's, or society's perspective. Significant events have arisen in the past two decades, including the emphasis on outcomes research, recent recommendations to adopt evidence-based microsurgery, and the inclusion in academic training programs of the competency "manager" to the health care system. This necessitates rethinking the way we report outcomes in microsurgery. This article explains the need to (1) use health-related quality-of-life scales to measure the benefits of microsurgical interventions, (2) measure outcomes with high-quality clinical research designs, and (3) incorporate proper cost-effectiveness studies in our clinical research before adopting new technologies such as new free flaps or techniques.
显微外科手术结果的报告一直存在差异。从历史上看，重点分别放在游离组织移植或断指再植时皮瓣和指体的存活或失败上。对于断指再植，运动范围或握持力等指数也可用于测量结果；头颈部显微外科手术的进食或说话能力，以及下肢显微外科手术的行走或恢复工作能力。虽然这与结果相关，但这种结果报告可能无法从患者、第三方付款人或社会的角度捕捉显微外科干预的效果。在过去的二十年中出现了一些重大事件，包括对结果研究的重视、最近建议采用循证显微外科技术，以及在学术培训计划中纳入医疗保健系统的“管理者”胜任力。这需要重新思考我们在显微外科手术中报告结果的方式。本文解释了需要（1）使用健康相关的生活质量量表来衡量显微外科干预的益处，（2）使用高质量的临床研究设计来衡量结果，以及（3）在采用新技术（如新游离皮瓣或技术）之前，在我们的临床研究中纳入适当的成本效益研究。
