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Table 4 Conversion of MDT treatment recommendations

From: Multidisciplinary team meetings for patients with complex extremity defects: a retrospective analysis of treatment recommendations and prognostic factors for non-implementation

Reason for non-implementation MDT treatment recommendation Final course of action
Patient’s preference Implant removal ankle, free flap reconstruction lower leg Implant removal, conservative wound treatment, shock wave therapy
Patient’s preference Lower leg amputation Conservative wound treatment, negative pressure therapy
Patient’s preference Lower leg amputation Conservative wound treatment
Patient’s preference Lower leg amputation Ilizarov bone transport
Patient’s preference Free flap reconstruction, ankle arthrodesis with bone grafting Free flap reconstruction, simple osteosynthesis
Patient’s preference Lower leg amputation Conservative wound treatment, negative pressure therapy
Comorbidity (severe PVD) AV-Loop, free flap reconstruction lower leg Iliac artery angioplasty, femoral artery angioplasty,
PTA A. poplitea, lower leg amputation, prosthesis
Comorbidity (severe PVD) Vascular imaging, free flap reconstruction, lower limb amputation Transfemoral amputation
New clinical information (insufficient perfused soft tissue and muscles) Humerus reconstruction by fibular free flap reconstruction, plate osteosynthesis, radial artery reconstruction, fasciocutaneous free flap reconstruction, median nerve reconstruction through sural nerve grafting Upper limb amputation, prosthesis
New clinical information (new inguinal wound healing problem) Femur-removal, lower leg amputation, reconstruction with osteomyocutaneous turn-up plasty as described by Sauerbruch Femur-removal, lower leg amputation, reconstruction with osteomyocutaneous turn-up plasty as described by Sauerbruch, pedicled flap reconstruction
Comorbidity (severe PVD) Vascular imaging, Free flap reconstruction, lower limb amputation Transfemoral amputation
New clinical information (soft tissue of forefoot viable) Forefoot amputation, chimeric free flap reconstruction of foot Osteosynthesis, free flap reconstruction of the feet, skin grafting
  1. MDT multidisciplinary team, PVD peripheral vascular disease, PTA percutaneous transluminal angioplasty