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. Design: 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. Setting: Academic tertiary care medical center. Intervention: 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). Main Outcome Measures: Direct (inpatient hospital resources used and monetary costs) and intangible (postoperative 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.