The Safety of Microvascular Free Tissue Transfer in the Elderly Population

Abstract

The objective of this study was to evaluate the safety and thus the efficacy of microvascular free tissue transfer in the elderly patient population. Free flaps for different types of reconstructions were analyzed to verify whether free tissue transfer is feasible in the elderly. Between 1993 and 2003, 102 free flaps were performed in 94 patients who were aged 70 years or older. There were 75 male and 19 female patients, with a mean age of 73.8 years (range, 70 to 87 years). Different types of free flaps were performed for head and neck (n = 78), lower extremity (n = 12), and trunk and upper extremity (n = 4) reconstruction. Nine flaps underwent reexploration and four of them were lost, for an overall success rate of 96 percent. Medical complications in the postoperative period were further evaluated. A total of 32 medical complications were seen in 29 patients. Only one patient died because of postoperative complications. The frequency of medical complications was further analyzed in detail. Effects of American Society of Anesthesiologists status, operation time, and age on complication rate were evaluated statistically. Only American Society of Anesthesiologists status was statistically significant for the occurrence of postoperative medical complications; class III and IV patients were at higher risk than class I and II. Neither operation time nor age was predictive of postoperative complications. Microvascular free tissue transfer is a safe and reliable option in the elderly population. The success rate of free flaps is not different from that for other age groups. The rate of postoperative medical complications was 31 percent (29 of 94 patients); most complications were in American Society of Anesthesiologists class III and IV patients.

Free Anterolateral Thigh Perforator Flap for Head and Neck Cancer Resection in a Nonagenarian

“…In a large retrospective series examining free flap reconstruction in 100 consecutive patients over the age of 65, Serletti et al also concluded that age should not be a contraindication for free flap transfer, and that the ASA status and operative time are significant predictors of medical and surgical morbidity [11]. Chick et al and Coskunfirat et al produced similar findings in populations groups of over 65 and 70s [12,13]. Specific to octogenarians, Blackwell et al published their experience in free flap head and neck reconstruction in 13 patients and found it a reliable reconstructive method, albeit one associated with a higher likelihood of medical complications and higher associated economic cost [14].…”

Microvascular tissue transfers in the elderly: safety analysis for a challenging area

“…The ASA scoring system was the dominant system used in the literature (2)(3)(4)(5)(6)(8)(9)(10)(12)(13)(14)(17)(18)(19)(20). Three studies calculated CCI scores (3,21,22) and only one study used the KFI (11).…”

“…Preoperative comorbidities and tools for their assessment were also investigated. Many studies agreed that these conditions are risk factors for systemic complications, but some favored the ASA classification (4)(5)(6)(8)(9)(10), some the CCI (3), and some the Kaplan Feinstein Index (KFI) (11), so there was no consensus on the method of assessment. Longer surgical duration's effect on complications and mortality is another area of debate (4,5,8).…”

“…Age was stated as an independent risk factor for morbidity in some studies (1-4), but others had opposite results (5)(6)(7)(8)(9). Preoperative comorbidities and tools for their assessment were also investigated.…”

Anestesia e retalhos microvascularizados

“…Chronological age alone is neither a contraindication for surgery nor a risk for postoperative morbidity and flap failure 8,9 . A preoperative high ASA status is associated with higher postoperative morbidity 10,11 . Patients with head and neck cancer are often elderly, smokers, with a history of alcoholism and, therefore, associated with comorbidity (heart and lung), sometimes associated with poor nutritional status.…”