Defining orthoplastic limb salvage centers: a systematic review

Clinical Snapshot

Key Findings

• P Value: Multiple significant differences: plastic surgery consultation criteria (p<0.001), surgical outcomes (p<0.001), centralized network integration (p≤0.006)

• Effect Size: Orthoplastic and vascular centers represented 77% of all limb salvage center studies

• Primary Outcome: Six organizational features characterized orthoplastic centers with >70% prevalence

• Nnt Or Sensitivity: Reporting score based on 26 organizational features across six structural care domains

• Confidence Interval: Not reported in abstract

Clinical Application

Framework appears implementable in established healthcare systems with existing trauma networks Relevant to Australian major trauma centers and state trauma networks. Could inform TGA device approval pathways and support RACS trauma surgery training standards. May influence PBS funding models for complex limb salvage procedures Australian limb salvage services, major trauma centers, and multidisciplinary teams managing complex limb reconstruction

Abstract

INTRODUCTION: Limb salvage centers have increased in number over time, but lack standardized defining criteria. This systematic review aimed to assess organizational features of limb salvage centers and determine whether orthoplastic centers, in comparison to vascular limb salvage centers, represent a distinct care model that may benefit from standardization. METHODS: We conducted a systematic review of publications related to limb salvage centers by searching MEDLINE, Embase, Web of Science, and Cochrane databases from their inception through 2024. We quantified binary data extraction as a reporting score of 26 organizational features across six structural care domains for limb salvage centers, based on a validated quality measurement framework. Organizational features differentiating distinct center types were identified to establish a quality framework for orthoplastic centers. Statistical comparisons between center types were performed using appropriate tests (p < 0.05). RESULTS: Of 118 included studies, orthoplastic (n = 43) and vascular (n = 48) centers represented 77% of all studies. Recent increases in orthoplastic publications show substantial variability in organizational features. Orthoplastic center literature more frequently reported plastic surgery consultation criteria (p < 0.001), surgical outcomes (p < 0.001), and centralized network integration (p ≤ 0.006), highlighting acute reconstructive approaches. Vascular center studies documented significantly more organizational team features (p < 0.001) and quality systems (p = 0.033), reflecting established care frameworks for chronic disease management. Six organizational features characterized orthoplastic centers with > 70% prevalence, providing a benchmark framework with standardization priorities. CONCLUSION: Orthoplastic limb salvage centers demonstrate distinct care paradigms that benefit from standardization. Our findings suggest structural benchmarks to support the need for standardized development of orthoplastic limb salvage centers.

References

1. 1.Moussa, O., Pacheco, F. J., Raasveld, F. V., Gonzalez, M. R., Oflazoglu, K., Ritt, M. J. P. F., Valerio, I. L., Rakhorst, H., Tuaño, K. R., & Eberlin, K. R. (2026). Defining orthoplastic limb salvage centers: a systematic review. Archives of Orthopaedic and Trauma Surgery. https://doi.org/10.1097/GOX.0000000000004551