Microvascular free tissue transfer in elderly patients: the Toronto experience.
BACKGROUND
Microvascular free tissue transfer has become an accepted and versatile method of reconstruction in the head and neck region, offering a one-stage procedure and thus reducing the number and length of hospital stays. Many of the patients requiring head and neck free flaps are elderly, with concomitant medical problems, including respiratory and cardiovascular compromise, and are therefore potentially at higher risk of adverse outcomes. In addition, they frequently have a history of heavy alcohol and cigarette consumption, which can compound the risks.


METHODS
We analyzed a series of 288 intraoral free flap reconstructions and arbitrarily divided them into four groups depending on age: <50, 51-60, 61-70, >70. These reconstructions were all performed for malignant lesions. Preoperative medical problems, including ischemic heart disease, hypertension, chronic obstructive pulmonary disease, peripheral vascular disease, and diabetes, were assessed and compared among the different age groups.


CONCLUSIONS
Our results suggest that free flap surgery is a safe technique in elderly patients with comparable surgical complications to a younger patient population. As a result of concomitant medical problems, however, postoperative medical complications are more frequent in the older age groups, with a resultant increase in length of hospital stay.
Beausang
Eamon S
ES
Division of Plastic and Reconstructive Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada.
Ang
Erik E
EE
Lipa
Joan E
JE
Irish
Jonathan C
JC
Brown
Dale H
DH
Gullane
Patrick J
PJ
Neligan
Peter C
PC
D017677:Age Distribution; D000368:Aged; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology*; D016491:Peripheral Vascular Diseases / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology*; D013524:Surgical Flaps / Q000098:blood supply*