A COMPARISON OF RESOURCE COSTS FOR HEAD AND NECK RECONSTRUCTION WITH FREE AND PECTORALIS MAJOR FLAPS

A series of 178 immediate reconstructions with regional or distant tis sue for repair of oropharyngeal defects caused by treatment of head an d neck cancer was reviewed to determine whether reconstruction with fr ee flaps was more or less expensive than reconstruction with regional myocutaneous flaps. In this series, three types of flaps were used: th e radial forearm free flap (n = 89), the rectus abdominis free flap (n = 56), and the pectoralis major myocutaneous flap (n = 33). Resource costs were determined by adding all costs to the institution of provid ing each service studied using salaried employees (including physician s). The two free-flap groups were combined to compare free flaps with the pectoralis major myocutaneous flap, a regional myocutaneous flap. Failure rates in the two groups were similar (3.0 percent for pectoral is major myocutaneous flap, 3.4 percent for free flaps). The mean cost s of surgery were slightly higher for the free flaps, but the subseque nt hospital stay costs were lower. Therefore, the total mean resource cost for the free-flap group ($28,460) was lower than the cost for the myocutaneous-flap group ($40,992). The pectoralis major myocutaneous flap may have been selected for more patients with advanced disease an d systemic medical problems, contributing to longer hospitalization an d added cost. Nevertheless, this study suggests that free flaps are no t more expensive than other methods and may provide cost savings for s elected patients.