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Free vs Pedicled Soft Tissue Transfer

Terance T. Tsue, MD; Stella S. Desyatnikova; Frederic W.-B. Deleyiannis, MD, MPhil, MPH; Neal D. Futran, MD; Brendan C. Stack, Jr, MD; Ernest A. Weymuller, Jr, MD; Michael G. Glenn, MD

Arch Otolaryngol Head Neck Surg. 1997;123(7):731-737.

Abstract
Objective
To compare the cost and functional results of free and pedicled soft tissue reconstruction after posterior oral cavity and oropharyngeal extirpation.

Design
Retrospective study of 53 consecutive patients undergoing extirpation with primary soft tissue reconstruction from January 1, 1991, to December 31, 1995. Median follow-up was 298 days.

Setting
Academic tertiary care medical center.

Intervention
Twenty-four patients underwent reconstruction with a pedicled pectoralis major myocutaneous flap (PMMF); 29 patients, with a fasciocutaneous free flap (FF) (27 radial forearm, 1 lateral arm, and 1 scapular).

Main Outcome Measures
Direct (inpatient hospital resources used and monetary costs) and intangible (postoperative complications and function) costs.

Results
Operative time was longer for FF reconstructions (P=.003), but both patient groups had similar intensive care unit and hospital stays. Treatment cost for FF reconstructions was $41 122, compared with $37 160 for PMMF reconstructions (P=.003). This difference was due to increased professional fees for FF reconstruction (P<.001), which was offset by intangible cost differences. The PMMF group tended toward an increased rate of flap-related complications, compared with the FF group. At last follow-up, 4 patients in the FF group (15%) and 3 in the PMMF group (15%) had their tracheotomy. In contrast, 17 (85%) patients in the PMMF group and 11 (39%) patients in the FF group required enteral tube feedings (P=.002). Also, 18 (64%) patients in the FF group were eating at least a soft diet compared with 6 (30%) patients in the PMMF group (P=.02).

Conclusions
Comparison of direct costs reveals only a modest difference in reconstruction costs that is outweighed by the intangible costs of PMMF reconstruction. The functional benefits of FF reconstruction appear to justify its slight increased expense and its use rather than PMMF reconstruction after extirpation in the posterior oral cavity and oropharynx.

Arch Otolaryngol Head Neck Surg. 1997;123:731-737

Author Affiliations
From the Department of Otolaryngology—Head and Neck Surgery, University of Kansas School of Medicine, Kansas City (Dr Tsue); and the Department of Otolaryngology—Head and Neck Surgery, University of Washington School of Medicine (Ms Desyatnikova and Drs Deleyiannis, Futran, Stack, and Weymuller), and the Virginia Mason Medical Clinic (Dr Glenn), Seattle, Wash.

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