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 pedi cled soft tissue reconstruction after posterior oral cavity and oropha ryngeal extirpation. Design: Retrospective study of 53 consecutive pat ients undergoing extirpation with primary soft tissue reconstruction f rom January 1, 1991, to December 31, 1995. Median follow-up was 298 da ys. Setting: Academic tertiary care medical center. Intervention: Twen ty-four patients underwent reconstruction with a pedicled pectoralis m ajor myocutaneous flap (PMMF); 29 patients, with a fasciocutaneous fre e flap (FF) (27 radial forearm, 1 lateral arm, and 1 scapular). Main O utcome Measures: Direct (inpatient hospital resources used and monetar y costs) and intangible (postoperative complications and function) cos ts. 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 wi th $37 160 for PMMF reconstructions (P=.003). This difference was due to increased professional fees for FF reconstruction (P<.001), which w as 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 t he PMMF group (15%) had their tracheotomy. In contrast, 17 (85%) patie nts in the PMMF group and 11 (39%) patients in the FF group required e nteral 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 th e 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 an d its use rather than PMMF reconstruction after extirpation in the pos terior oral cavity and oropharynx.