Comparison of cost and function in reconstruction of the posterior oral cavity and oropharynx. Free vs pedicled soft tissue transfer.
OBJECTIVE
To compare the cost and functional results of free and pedicled soft tissue reconstruction after posterior oral cavity and oropharyngeal extirpation.


METHODS
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.


METHODS
Academic tertiary care medical center.


METHODS
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).


METHODS
Direct (inpatient hospital resources used and monetary costs) and intangible (post-operative 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.
Tsue
T T
TT
Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City 66160, USA.
Desyatnikova
S S
SS
Deleyiannis
F W
FW
Futran
N D
ND
Stack
B C
BC
Weymuller
E A
EA
Glenn
M G
MG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000191:economics / Q000503:physiopathology / Q000601:surgery; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000503:physiopathology / Q000601:surgery*; D009062:Mouth Neoplasms / Q000191:economics / Q000503:physiopathology / Q000601:surgery; D009959:Oropharyngeal Neoplasms / Q000191:economics / Q000503:physiopathology / Q000601:surgery; D009960:Oropharynx / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000191:economics; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000191:economics* / Q000379:methods; D014861:Washington