Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases

Abstract

Background In elderly patients, complex soft tissue defects are increasingly observed due to the prolonged life expectancy and accompanying comorbidities. The aim of this study is to evaluate whether free tissue transfer is safe in very old patients without additional risk and complications. Methods All patients older than 65 years undergoing free tissue transfer between November 2007 and September 2016 were reviewed in a retrospective study. Two cohorts were compared regarding perioperative morbidity and postoperative outcome (cohort 1 [old patients, ages 65–79]; cohort 2 [very old patients, ages ≥ 80]). Results In total, 256 patients were included in the study (cohort 1 [n = 217]; cohort 2 [n = 39]). Overall, 262 free flaps were performed due to a second microsurgical reconstruction in six cases. No statistically significant differences between cohorts were observed regarding surgical complications, total flap losses, and mortality. Detailed evaluation of cohort 2 revealed a significant learning curve during the observation period regarding the perioperative management and procedure of soft tissue reconstruction: operation length as well as postoperative intensive care unit stay decreased significantly over time (p < 0.05) and also surgical complications showed a positive trend (p = 0.07). We ascertained a shift toward a “more reliable” flap selection from predominantly anterolateral thigh flap) to axial flaps such as rectus abdominis and latissimus dorsi flaps. Conclusion Our study showed that age is not associated with an increased risk of postoperative complications. Reliable muscle free flaps, two-stage procedures, and safe vascular supply are important strategic aspects to achieve microvascular tissue transfer with high success rates in geriatric patients.

The Role of Free Tissue Transfers for Defect Coverage over the Body in Geriatric Populations

“…Most studies investigated the rate of surgical and medical complications and the rate of mortality as well. The surgical and medical complications vary between 8 and 33%, depending on the sample size [ 8 , 10 , 11 , 12 ].…”

A Structured, Microsurgical Training Curriculum Improves the Outcome in Lower Extremity Reconstruction Free Flap Residency Training: The Ludwigshafen Concept

“…In general, 5th and 6th-year residents are eligible for free flap training. Despite patients age is not associated with a higher postoperative complication rate, 19 patient safety relies on precise preoperative planning with a focus not only on defect characteristics, recipient vessel conditions, or skills of the surgeon but likewise on the free flap chosen for soft tissue reconstruction. It is common sense that free perforator flaps require higher technical expertise and therefore this flap type is considered as an "advanced" flap in the context of microsurgical training by many authors.…”

Microvascular reconstruction for maxillofacial defects: a retrospective analysis of outcomes and complications in 121 consecutive cases

“…It has been reported that as the operation time increases, the level of risk increases, particularly in terms of the incidence of rhabdomyolysis, fluid and electrolyte disturbances, deep vein thrombosis, and hypothermia [ 20 , 21 ]. According to various reports [ 22 – 25 ], operation times vary from 376 to 817 min for maxillofacial microvascular reconstruction . Crawley et al [ 26 ] reported a mean ischemic time of 115.4 ± 35.7 min among 849 cases and a mean operation time of 732 ± 144 min among 650 cases.…”