Pectoralis Major Myocutaneous Flap vs Revascularized Free Tissue Transfer: Complications, Gastrostomy Tube Dependence, and Hospitalization

• Published in: Archives of otolaryngology--head & neck surgery Vol. 130; no. 2; pp. 181 - 186
• Main Authors: Chepeha, Douglas B, Annich, Gail, Pynnonen, Melissa A, Beck, Jill, Wolf, Gregory T, Teknos, Theodoros N, Bradford, Carol R, Carroll, William R, Esclamado, Ramon M
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01.02.2004
• Subjects: Biological and medical sciences; Combined surgery. Multiple transplantations; Female; Gastrostomy; Head and Neck Neoplasms - surgery; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Muscles - blood supply; Muscles - transplantation; Pectoralis Muscles - surgery; Postoperative Complications; Reconstructive Surgical Procedures - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps; Gastrostomy; Human; Treatment; Surgery; Free flap; Complication; Hospitalization; Musculocutaneous flap; Pectoralis major muscle; Comparative study
• ISSN: 0886-4470; 2168-6181; 1538-361X; 2168-619X
• DOI: 10.1001/archotol.130.2.181

OBJECTIVE To evaluate the factors related to surgical complications, rate of gastrostomy tube (G-tube) dependence, and hospitalization in patients undergoing reconstruction with a pectoralis myocutaneous flap vs a soft-tissue revascularized flap. DESIGN Quasi-experimental case series with a historic control group. POPULATION A total of 179 patients (138 men and 41 women) with a mean (SD) age of 58 (14) years treated between January 1, 1986, and December 31, 1995, with a pectoralis flap (108 patients) or a revascularized free flap (71 patients). METHODS Inclusion criteria were first or second extirpation, reconstruction with soft-tissue flap, or defect including the upper aerodigestive tract. Exclusion criteria were secondary reconstruction, or reconstruction for salvage of a complication. RESULTS Although the major complication rate was not significantly different according to reconstructive approach, hypopharyngeal defects had a significantly higher major complication rate of 30% (6/20) compared with 8% (13/159) for other defect sites (P<.003). The minor complication rate was higher in the pectoralis group, at 57% (62/108), than in the revascularized flap group, at 21% (15/71) (P<.001). G-tube dependence was higher in the pectoralis group at 42% (40/96), in contrast to the revascularized flap group at 16% (10/63) (P<.001). G-tube dependence was 25% higher in patients who underwent salvage surgery after radiation (42% [30/72]) than in patients treated with postoperative radiation (17% [12/69]) (P<.004). Revascularized flaps helped ameliorate the effects of radiation before surgery; 56% (23/41) of the patients who received pectoralis flaps were G-tube dependent, while the rate of G-tube dependence in the revascularized flap group was 23% (7/31) (P<.004). Hospitalization was longer in the pectoralis group (14 days) than the revascularized flap group (12 days) (P<.006). CONCLUSION Patients who undergo reconstruction with a pectoralis flap have significantly higher minor complication rates, a higher rate of G-tube dependence, and longer hospitalization than patients who undergo reconstruction with a soft-tissue revascularized flap.Arch Otolaryngol Head Neck Surg. 2004;130:181-186 -->