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Pectoralis Major Myocutaneous Flap vs Revascularized Free Tissue Transfer
Complications, Gastrostomy Tube Dependence, and Hospitalization
Douglas B. Chepeha, MD, MSPH;
Gail Annich, MD, MSPH;
Melissa A. Pynnonen, MD;
Jill Beck, MD;
Gregory T. Wolf, MD;
Theodoros N. Teknos, MD;
Carol R. Bradford, MD;
William R. Carroll, MD;
Ramon M. Esclamado, MD
Arch Otolaryngol Head Neck Surg. 2004;130:181-186.
Objective To evaluate the factors related to surgical complications, rate of gastrostomy tube (G-tube) dependence, and hospitalization in patients undergoing reconstruction with a pectoralis myocutaneous flap vs a soft-tissue revascularized flap.
Design Quasi-experimental case series with a historic control group.
Population A total of 179 patients (138 men and 41 women) with a mean (SD) age of 58 (14) years treated between January 1, 1986, and December 31, 1995, with a pectoralis flap (108 patients) or a revascularized free flap (71 patients).
Methods Inclusion criteria were first or second extirpation, reconstruction with soft-tissue flap, or defect including the upper aerodigestive tract. Exclusion criteria were secondary reconstruction, or reconstruction for salvage of a complication.
Results Although the major complication rate was not significantly different according to reconstructive approach, hypopharyngeal defects had a significantly higher major complication rate of 30% (6/20) compared with 8% (13/159) for other defect sites (P<.003). The minor complication rate was higher in the pectoralis group, at 57% (62/108), than in the revascularized flap group, at 21% (15/71) (P<.001). G-tube dependence was higher in the pectoralis group at 42% (40/96), in contrast to the revascularized flap group at 16% (10/63) (P<.001). G-tube dependence was 25% higher in patients who underwent salvage surgery after radiation (42% [30/72]) than in patients treated with postoperative radiation (17% [12/69]) (P<.004). Revascularized flaps helped ameliorate the effects of radiation before surgery; 56% (23/41) of the patients who received pectoralis flaps were G-tube dependent, while the rate of G-tube dependence in the revascularized flap group was 23% (7/31) (P<.004). Hospitalization was longer in the pectoralis group (14 days) than the revascularized flap group (12 days) (P<.006).
Conclusion Patients who undergo reconstruction with a pectoralis flap have significantly higher minor complication rates, a higher rate of G-tube dependence, and longer hospitalization than patients who undergo reconstruction with a soft-tissue revascularized flap.
From the Departments of Otolaryngology–Head & Neck Surgery (Drs Chepeha, Pynnonen, Wolf, Teknos, and Bradford) and Pediatrics (Dr Annich), University of Michigan, Ann Arbor; Division of Otolaryngology, University of Alabama–Birmingham (Dr Carroll); and Department of Otolaryngology, Cleveland Clinic Foundation, Cleveland, Ohio (Dr Esclamado). Dr Beck is in private practice in Boise, Idaho. The authors have no relevant financial interest in this article.
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