title: Free radial forearm flap versus pectoralis major myocutaneous flap reconstruction of oral and oropharyngeal defects: a cost analysis.
abstract: OBJECTIVE
  The free radial forearm flap has replaced the pedicled pectoralis major myocutaneous flap and it has become the 'workhorse flap' used by many head and neck reconstructive surgeons for soft tissue reconstructions. Cost implications of radial forearm flap reconstruction within the context of the overall health care in a particular system need to be investigated particularly before it is labelled as 'costly only'.
  
  
  METHODS
  Forty patients who underwent immediate free radial forearm flap reconstruction for oral or oropharyngeal soft tissue defects were matched with patients who underwent pectoralis major myocutaneous flap reconstruction for similar defects. The 2 years of which the overall management costs according to the hospital perspective were calculated were divided into four periods: operative period, the postoperative phase, follow-up during first year and follow-up during second year after discharge.
  
  
  RESULTS
  The total costs within the first 2 years were comparable at approximately 50,000 Euros. The lower costs of hospital admission (24 days versus 28 days; P = 0.005) in the postoperative phase outweighed the higher costs of the surgical procedure (692 min versus 462 min; P < 0.005) in radial forearm flap patients when compared with pectoralis major flap patients.
  
  
  CONCLUSIONS
  Oral and oropharyngeal reconstruction with radial forearm flap is not more costly than pectoralis major flap reconstruction. Given the better functional outcome and the present cost analysis, reconstruction of oral and oropharyngeal defects is preferably performed using free tissue transfer.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands. r.bree@vumc.nl
authors.forename: R
authors.initials: R
authors.lastname: de Bree
authors.forename: R
authors.initials: R
authors.lastname: Reith
authors.forename: J J
authors.initials: JJ
authors.lastname: Quak
authors.forename: C A
authors.initials: CA
authors.lastname: Uyl-de Groot
authors.forename: M
authors.initials: M
authors.lastname: van Agthoven
authors.forename: C R
authors.initials: CR
authors.lastname: Leemans
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003365:Costs and Cost Analysis; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000098:blood supply* / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000379:methods*; D018709:Statistics, Nonparametric; D013524:Surgical Flaps; D016896:Treatment Outcome