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Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization.

Publication ,  Journal Article
Chepeha, DB; Annich, G; Pynnonen, MA; Beck, J; Wolf, GT; Teknos, TN; Bradford, CR; Carroll, WR; Esclamado, RM
Published in: Arch Otolaryngol Head Neck Surg
February 2004

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.

Duke Scholars

Published In

Arch Otolaryngol Head Neck Surg

DOI

ISSN

0886-4470

Publication Date

February 2004

Volume

130

Issue

2

Start / End Page

181 / 186

Location

United States

Related Subject Headings

  • Surgical Flaps
  • Postoperative Complications
  • Plastic Surgery Procedures
  • Pectoralis Muscles
  • Otorhinolaryngology
  • Muscles
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
 

Citation

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MLA
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Chepeha, D. B., Annich, G., Pynnonen, M. A., Beck, J., Wolf, G. T., Teknos, T. N., … Esclamado, R. M. (2004). Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization. Arch Otolaryngol Head Neck Surg, 130(2), 181–186. https://doi.org/10.1001/archotol.130.2.181
Chepeha, Douglas B., Gail Annich, Melissa A. Pynnonen, Jill Beck, Gregory T. Wolf, Theodoros N. Teknos, Carol R. Bradford, William R. Carroll, and Ramon M. Esclamado. “Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization.Arch Otolaryngol Head Neck Surg 130, no. 2 (February 2004): 181–86. https://doi.org/10.1001/archotol.130.2.181.
Chepeha DB, Annich G, Pynnonen MA, Beck J, Wolf GT, Teknos TN, et al. Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization. Arch Otolaryngol Head Neck Surg. 2004 Feb;130(2):181–6.
Chepeha, Douglas B., et al. “Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization.Arch Otolaryngol Head Neck Surg, vol. 130, no. 2, Feb. 2004, pp. 181–86. Pubmed, doi:10.1001/archotol.130.2.181.
Chepeha DB, Annich G, Pynnonen MA, Beck J, Wolf GT, Teknos TN, Bradford CR, Carroll WR, Esclamado RM. Pectoralis major myocutaneous flap vs revascularized free tissue transfer: complications, gastrostomy tube dependence, and hospitalization. Arch Otolaryngol Head Neck Surg. 2004 Feb;130(2):181–186.

Published In

Arch Otolaryngol Head Neck Surg

DOI

ISSN

0886-4470

Publication Date

February 2004

Volume

130

Issue

2

Start / End Page

181 / 186

Location

United States

Related Subject Headings

  • Surgical Flaps
  • Postoperative Complications
  • Plastic Surgery Procedures
  • Pectoralis Muscles
  • Otorhinolaryngology
  • Muscles
  • Middle Aged
  • Male
  • Length of Stay
  • Humans