Analysis of cost and outcomes in bony versus soft tissue midface free flap reconstruction

Angela Alnemri, Ramez Philips, Sarah Sussman, Vivian Xu, Alyssa Givens, Anjali Patel, Brian Swendseid, Aarti Agarwal, Scott Keith, Ayako Shimada, Yamil Selman, David M. Cognetti, Ryan Heffelfinger, Richard Goldman, Adam J. Luginbuhl, Mark K. Wax, Larissa Sweeny, Joseph M. Curry

Research output: Contribution to journalArticlepeer-review


Background: Outcomes and cost of soft tissue versus bony midface free flap reconstruction (MR) with and without virtual surgical planning (VSP) were evaluated. Methods: Retrospective review of MR including ischemic time (IT), operative duration (OD), length of stay (LOS), and total cost (TC). Eighty-one soft tissue and 76 bony MR (VSP = 23) were reviewed. Results: Bony MR was used for higher complexity defects (p = 0.003) and was associated with higher IT (p < 0.001), OD (p < 0.001), LOS (p = 0.032), and TC (p < 0.001). VSP was associated with a mean 111.2 ± 37.9 minute reduction in OD (p = 0.004) compared to non-VSP bony flaps. VSP was associated with higher itemized cost, but no increase in TC (p = 0.327). Conclusions: Bony MR was used for higher complexity MR and was associated with increased TC, LOS, OD, and IT. VSP shortened OD with no significant increase in TC.

Original languageEnglish (US)
Pages (from-to)1896-1908
Number of pages13
JournalHead and Neck
Issue number8
StatePublished - Aug 2022


  • cost analysis
  • free flap
  • midface
  • operative duration
  • virtual surgical planning

ASJC Scopus subject areas

  • Otorhinolaryngology


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