Economic Analysis of Reconstruction for Fasciocutaneous Head and Neck Defects

Background: Advanced head and neck surgical defects can present a complex reconstructive challenge. Free tissue transfer (FTT) has been the mainstay of treatment for these cases (1), but Keystone island flaps (KIF) are an emerging alternative with comparable reconstructive outcomes (2). While the primary considerations in head and neck reconstruction remain the adequate restoration of function, esthetics and minimization of post-operative morbidity and mortality (3,4), the worldwide trend towards population aging and fiscal responsibility prompted us to compare FTT with KIF for head and neck reconstruction in terms of operative time, length of in-patient stay and total admission cost (5).

Methods: A retrospective review of patients undergoing reconstruction of head and neck surgical defects with keystone or free flaps between 01/07/2008 and 30/06/2011 was performed. Patient records were reviewed, and admission costs obtained.

Results: 10 free flaps and 20 keystone perforator island flap cases in similar patients with similar defects were reviewed. Keystone flap cases required shorter operating times (241.2 minutes compared to 466.0 minutes, p<0.001) and shorter admissions (8.2 days compared to 11.7 days, p=0.02), resulting in a lower overall cost of admission (mean admission cost A$18,537.96 compared to A$29,690.65, p=0.002).

Conclusions: Keystone island flaps are a complementary reconstructive alternative to free tissue transfer in the management of complex fasciocutaneous head and neck surgical defects. They have a lower financial cost, shorter operative times and reduced length of stay, making them a valuable alternative to microsurgical reconstruction in our aging populations.