title: Surgical outcomes in the elderly patient after osteocutaneous free flap transfer.
abstract: OBJECTIVE
  Morbidity of free tissue transfer in the elderly patient is controversial. Recent studies have shown no significant difference in elderly fasciocutaneous free-flap donor site morbidity. The purpose of this study is to assess surgical outcomes in elderly patients receiving osteocutaneous free-tissue transfer.
  
  
  METHODS
  Retrospective chart review of patients 70 years and older undergoing osteocutaneous free flaps from 2000 to 2013.
  
  
  METHODS
  Fibular, radial forearm, and scapular flaps were reviewed. Younger patients randomly selected from the same time period served as controls. Data collected included donor site morbidity, flap complications, feeding tube and tracheostomy dependence, and hospital stay.
  
  
  RESULTS
  Forty-four osteocutaneous free flaps were performed in elderly patients. Overall, there was no significant difference in donor site morbidity between older and younger patients (P = 0.50) (tendon exposure, P = 1.00; split-thickness skin graft loss, P = 0.36; infections, P = 0.52; dehiscence, P = 1.00; and seroma, P = 1.00). There was no significant difference between older and younger patients being decannulated (P = 0.61) or the time to decannulation (P = 0.24). There was no difference in those who returned to baseline diet (P = 0.67). All patients returned to baseline ambulatory and shoulder status. Length of postoperative hospitalization (P = 0.78) and intensive care unit stay (P = 0.94) were also equal. The only significant difference was that more elderly patients were discharged to skilled nursing facilities (SNF) (40.9% vs. 15.9%, P < 0.01).
  
  
  CONCLUSIONS
  Elderly patients undergoing free tissue transfer have similar flap and donor site outcomes, feeding tube and tracheostomy outcomes, ambulatory status, and hospital stays compared to younger patients. They are, however, more likely to require SNF care posthospitalization.
  
  
  METHODS
  4.
authors.affiliation: School of Medicine and the, Oregon Health and Science University Portland, Oregon.
authors.forename: Tyler S
authors.initials: TS
authors.lastname: Weaver
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Wester
authors.forename: John P
authors.initials: JP
authors.lastname: Gleysteen
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Peck
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D058752:Free Tissue Flaps / Q000098:blood supply*; D015577:Geriatric Assessment / Q000379:methods; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000009:adverse effects / Q000379:methods; D013530:Surgical Wound Infection / Q000503:physiopathology*; D060053:Transplant Donor Site / Q000473:pathology* / Q000503:physiopathology; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Free flap; elderly; microvascular; osteocutaneous; outcomes