title: Free flaps in elderly patients: outcomes and complications in head and neck reconstruction after oncological resection.
abstract: BACKGROUND
  Free flaps represent the first reconstructive option for many head and neck defects. The increasing life expectancy of the population results in increasing numbers of ageing patients facing complex reconstructive surgery. In this study we evaluated our experience with free-flap transfers in older patients, analysing the post-operative reconstructive and systemic complications.
  
  
  METHODS
  Between 2000 and 2009, 360 patients underwent free flap reconstruction of defects resulting from the treatment of head and neck tumours at the Operative Unit of Maxillofacial Surgery, University - Hospital of Parma, Italy. Fifty-five patients (15.3%) were more than 75 years old at the time of treatment.
  
  
  RESULTS
  At the end of the follow-up successful free-flap transfer was achieved in 360 of the 373 flaps harvested (96.5%). The overall reconstructive complication rate was 31.4%, (31.8% in the younger group and 29.1% in the remaining patients). Medical complications were observed in 29.2% of cases (less than 75 years: 28.8%; more than 75 years: 30.9%). The ASA status was associated with a statistically significantly higher incidence of complications within patients less than 75 years old (p < 0.0001).
  
  
  CONCLUSIONS
  The results of this study, in agreement with previous studies, provide evidence that free-tissue transfer may be performed in ageing patients with a high degree of technical success. The chronologic age cannot be considered an appropriate criterion in the reconstructive decision. On the contrary, a careful selection of the patients based on comorbidities and general conditions (ASA status) is of primary importance in reducing post-operative complications and to improving the results of surgery.
authors.affiliation: Maxillo-Facial Surgery Operative Unit, Head and Neck Department, University-Hospital of Parma, Via Gramsci 14, 43100 Parma (Pr), Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ferrari
authors.forename: C
authors.initials: C
authors.lastname: Copelli
authors.forename: B
authors.initials: B
authors.lastname: Bianchi
authors.forename: A
authors.initials: A
authors.lastname: Ferri
authors.forename: T
authors.initials: T
authors.lastname: Poli
authors.forename: T
authors.initials: T
authors.lastname: Ferri
authors.forename: E
authors.initials: E
authors.lastname: Sesenna
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D000437:Alcoholism / Q000150:complications; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003422:Critical Care; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures / Q000379:methods*; D012907:Smoking; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents