J Reconstr Microsurg 2009; 25(9): 521-526
DOI: 10.1055/s-0029-1238218
© Thieme Medical Publishers

Cost Analysis of 109 Microsurgical Reconstructions and Flap Monitoring with Microdialysis

Leena Setälä1 , Heini Koskenvuori2 , Daiva Gudaviciene3 , Leena Berg1 , Paula Mustonen1
  • 1Department of Plastic Surgery, Kuopio University Hospital, Kuopio, Finland
  • 2Department of Accounting and Finance, Kuopio University Hospital, Kuopio, Finland
  • 3Department of Breast Surgery and Oncology, Vilnius University Institute of Oncology, Vilnius, Lithuania
Further Information

Publication History

Publication Date:
22 September 2009 (online)


Few studies have examined the cost-effectiveness of microsurgery, and little is known about the cost-effectiveness of flap monitoring. We studied the costs related to microsurgery during 2004 to 2006 in Kuopio University Hospital. A total of 99 patients were reconstructed with 109 flaps. Primary success was achieved in 64% of cases. Reoperation for anastomosis was conducted in 25% and for other surgical complications in 27%. The intended result was achieved in 94% of cases. The mean total cost of hospital care was 20,000 € in head and neck cancer surgery, 15,500 € in defects of the lower extremities, and 9200 € in breast reconstruction. The costs were greatly influenced by surgical complications (i.e., if the primary reconstruction failed, then the secondary microvascular flap almost doubled the expense involved; mean expenses per case 27,900 €). Microdialysis was used in flap monitoring with an additional cost of 535 € per patient. We found that microdialysis provided an early diagnosis of perfusion failure and helped to save the flap. It was estimated that if one or two flaps per year are saved due to more effective monitoring, then the extra costs of using microdialysis are covered.


Leena Setälä, M.D. , Ph.D. 

Department of Surgery, Kuopio University Hospital

PO Box 1777, 70211 Kuopio, Finland

Email: leena.setala@kuh.fi