title: Comparison of Clinical and Functional Outcomes Using Pectoralis Major and Cutaneous Free Flaps for Hypopharyngeal Squamous Cell Carcinoma.
abstract: BACKGROUND
  The purpose of this study was to compare postoperative morbidities and functional outcomes of pectoralis major myocutaneous (PMMC) flap and cutaneous free flap reconstruction approaches in hypopharyngeal squamous cell carcinoma patients.
  
  
  METHODS
  We retrospectively reviewed records from 99 patients who underwent hypopharyngeal reconstruction with a cutaneous free flap (n=85) or PMMC flap (n=14) between 1995 and 2013. Morbidity was classified into hospitalization, medical, or flap-related complications. Functional outcomes were classified into oral re-alimentation and decannulation time.
  
  
  RESULTS
  The overall flap-related complication rate was higher in the PMMC flap group (n=8, 57.1%; P=0.019), but the medical morbidity rate was higher in the cutaneous free flap group (n=68, 80%; P=0.006). The rate of pneumonia was higher in the cutaneous free flap group (n=48, 56.5%; P=0.020). Pulmonary premorbidity was the variable most significantly associated with pneumonia (odds ratio=3.012, P=0.012). There was no statistically significant difference in oral re-alimentation and decannulation time between the two groups.
  
  
  CONCLUSIONS
  Although the functional superiority of free flaps has been reported in many studies, our results do not support this hypothesis. One limitation of our study is the relatively smaller flap size and fewer PMMC flap cases compared with the cutaneous free flap group. The low postoperative medical morbidity incidence rate in the PMMC flap group was clinically significant; however, the free flap group had more flap-related complications. Thus, PMMC flaps should be considered a viable option, especially for patients with pulmonary premorbidities.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Taeyul
authors.initials: T
authors.lastname: Lee
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Chulhoon
authors.initials: C
authors.lastname: Chung
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Yongjoon
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Jaehyun
authors.initials: J
authors.lastname: Kim
keywords: Cutaneous free flap; Functional outcome; Hypopharynx; Pectoralis major flap; Postoperative complication