In our current cost-conscious medical environment, many have questioned whether complex surgical procedures such as free flaps would be supported in an era in which the cost of care plays a major role in determining patient treatment.20 Some investigators have pointed to the added operative time for free flaps, equating longer operative times with added postoperative complications. On the contrary, many studies have not supported this assumption.2-9 Comparative studies actually demonstrate lower postoperative complication rates in free flaps relative to pedicled flaps.4,5,21 In one study, the rate of fistula formation was significantly lower in the free flap group versus the pedicled flap group (4% vs 21%)19; overall surgical intensive care unit and hospital stay were shorter in the free flap group, resulting in a net reduction in the consumption of hospital resources.19 Another study found the mean resource cost associated with PMC flaps to be $48,917 versus $37,314 for free flaps despite the fact the free flap group had higher initial costs due to longer operative times.20 Complications such as wound infection, oropharyngeal fistula, and partial flap necrosis are all more common in patients reconstructed with a pedicle flap.20 These complications lead to longer hospitalization and higher ultimate costs for these patients. By choosing free flaps and initially investing more time and money, major wound complications are avoided, hospital stays shortened, and resource consumption reduced, making free flaps more cost-effective in the long-term.19

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