title: Prognosis as a determinant of free flap utilization for reconstruction of the lateral mandibular defect.
abstract: BACKGROUND
  The purpose of this study was to determine whether patients with a poor prognosis for survival were more likely to undergo reconstruction with a pectoralis flap versus a free flap and whether the use of a pectoralis flap offered any perioperative advantage, such as a reduction in medical complications.
  
  
  METHODS
  Fifty-five consecutive patients who underwent immediate reconstruction after a lateral mandibulectomy were retrospectively reviewed.
  
  
  RESULTS
  Age >or=70 years (p = .03), moderate or severe comorbidity (p = .02), and involvement of the base of tongue by tumor (p = .04) were significantly associated with decreased utilization of a free flap (n = 36). Comorbidity was the main determinant of medical complications (p = .001) and length of hospital stay (p = .03).
  
  
  CONCLUSIONS
  Expectations of prognosis bias the surgeon's decision regarding flap selection. Reconstruction with a pectoralis flap does not necessarily contribute toward the desired outcome of reduced medical complications. Any functional comparison between reconstructive groups needs to account for those differences in health status and prognosis that might explain any observed postoperative differences.
authors.affiliation: University of Pittsburgh, Division of Plastic and Reconstructive Surgery, Suite 6B Scaife Hall, 3550 Terrace Ave., Pittsburgh, PA 15261, USA. deleyiannisfw@msx.upmc.edu
authors.forename: Frederic W-B
authors.initials: FW
authors.lastname: Deleyiannis
authors.forename: Edward
authors.initials: E
authors.lastname: Lee
authors.forename: Brian
authors.initials: B
authors.lastname: Gastman
authors.forename: David
authors.initials: D
authors.lastname: Nguyen
authors.forename: James
authors.initials: J
authors.lastname: Russavage
authors.forename: Ernest K
authors.initials: EK
authors.lastname: Manders
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
authors.forename: Eugene N
authors.initials: EN
authors.lastname: Myers
authors.forename: Jonas
authors.initials: J
authors.lastname: Johnson
mesh_terms: D000367:Age Factors; D000368:Aged; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008334:Mandible / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012509:Sarcoma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D013524:Surgical Flaps