Sapsford Timothy, Wilson Zachary, Chen Fang Joe, Nightingale James, Grigg Roger, Anderson Daniel, Fitzgerald Garret
Otolaryngology Head and Neck Surgery, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia.
School of Medicine, Griffith University, Gold Coast, Queensland, Australia.
ANZ J Surg. 2025 Apr;95(4):658-663. doi: 10.1111/ans.19394. Epub 2025 Jan 11.
Australia has the highest global incidence of keratinocyte cancer. Surgically managing keratinocyte cancers in regional Australia presents geographic and economic challenges, which necessitate cost-effective resource allocation. Previous work has outlined the cost benefit for outpatient day surgical excision of head and neck skin lesions that can be closed primarily. We expand on this analysis with the inclusion of graft and local flap reconstructions.
A retrospective analysis was completed in a single regional centre across 24 months from July 2022 to June 2024. Patient demographics, lesion characteristics, margin status, cost comparison, and complication rates were recorded.
There were 256 excisions for proven or suspected keratinocyte cancers. Basal cell carcinomas comprised 73.1% of lesions, squamous cell carcinoma for 21.9% of lesions, and intra-epidermal carcinoma for 5.1%. Lesion defects were closed primarily in 63.8% while 23.0% underwent full thickness graft reconstruction and 13.2% required local flaps. Involved margins were reported in 8.1% of excisions. Follow-up wound review was undertaken in primary care for 26.1% of all lesion excisions. Average indicative costs were three-to-four times higher for procedures performed in theatre compared to the outpatient setting, and these savings were greatest for graft and local flap reconstructions. There were 20 recorded complications including 16 partial or complete graft failures and one partial flap failure.
This study demonstrates further cost effectiveness for graft and local flap reconstruction of head and neck skin excisions under local anaesthetic in the regional outpatient setting, while maintaining low complication and incomplete excision rates.
澳大利亚的角质形成细胞癌全球发病率最高。在澳大利亚地区对外科治疗角质形成细胞癌提出了地理和经济方面的挑战，这就需要进行具有成本效益的资源分配。先前的研究概述了对可直接缝合的头颈部皮肤病变进行门诊日间手术切除的成本效益。我们通过纳入植皮和局部皮瓣重建来扩展这一分析。
在一个单一的地区中心进行了一项回顾性分析，时间跨度为2022年7月至2024年6月的24个月。记录了患者人口统计学资料、病变特征、切缘状态、成本比较和并发症发生率。
对确诊或疑似角质形成细胞癌进行了256次切除。基底细胞癌占病变的73.1%，鳞状细胞癌占21.9%，表皮内癌占5.1%。63.8%的病变缺损直接缝合，23.0%进行了全厚植皮重建，13.2%需要局部皮瓣。8.1%的切除报告切缘受累。在初级保健中对所有病变切除的26.1%进行了随访伤口检查。与门诊环境相比，手术室进行的手术平均指示性成本高出三到四倍，而这些节省在植皮和局部皮瓣重建中最为显著。记录了20例并发症，包括16例部分或完全植皮失败和1例部分皮瓣失败。
本研究表明，在地区门诊环境中，局部麻醉下对头颈部皮肤切除进行植皮和局部皮瓣重建具有更高的成本效益，同时保持低并发症和不完全切除率。
