Orthoplastic Limb Salvage Centers: A Survey to Determine Essential Components and Framework for Implementation

Background: Management of patients with limb-threatening pathology represents a clinical challenge. Orthoplastic limb salvage centers have been developed to streamline care and improve patient outcomes for complex extremity pathology. However, no formal criteria exist for the establishment of orthoplastic limb salvage centers. We conducted a survey of orthoplastic limb salvage centers to assess current practice patterns and establish consensus-based criteria for the development of such centers. Methods: The American Society of Reconstructive Microsurgery membership was used to survey self-identified members of orthoplastic limb salvage centers in the United States. We evaluated current practices and recommended characteristics for team service structure, outcome tracking, quality systems, and barriers to standard implementation. Consensus rates (%) were calculated for current and recommended practice patterns, demonstrating implementation gaps. Results: Strong consensus exists for four criteria: orthoplastic multidisciplinary teams (100%), high case volume (96%), 24/7 service availability (87%), and standardized outcome tracking (83%). Specialist integration demonstrated strong agreement for vascular surgery, infectious disease, and physiatrists (83% each). Gaps in implementation were identified, including dedicated operation room (OR) time (48% current vs. 65% recommended) and standardized outcome measurement (52% current vs. 65% recommended). Primary barriers to development included lack of standardized outcome reporting (83%), insufficient institutional support (70%), and financial constraints (61%). Conclusion: This study provides a consensus-based framework for the development of orthoplastic limb salvage centers (of excellence). National survey results identify comprehensive multidisciplinary care, outcome metrics tracking, and quality systems as priority areas for standardization. Barriers to collaborative quality initiative development include the lack of universal standards, institutional support, and financial constraints.