title: Microsurgical reconstruction in patients greater than 80 years old.
abstract: BACKGROUND
  Demographic change implies that the human population is getting older and the elderly are living longer. Consequently, achieving good functional and aesthetic outcomes in microvascular procedures, especially in very old patients with higher incidence of atherosclerosis and vessel calcifications, constitutes a microsurgical challenge. This study evaluates the feasibility of microsurgical procedures in a very old patient cohort.
  
  
  METHODS
  Between 2009 and 2015, 754 patients underwent 838 free flap reconstructions. The patients were divided into two groups according to age in "middle-aged" (<80 years old; n = 711) or "very old" (≥80 years old; n = 43). The series was retrospectively analyzed regarding potential influence of medical comorbidities, surgical and medical complications and outcomes.
  
  
  RESULTS
  Between the groups, there was a significant difference regarding comorbidities with a higher prevalence of hypertension (P < 0.0001) and peripheral artery disease (P < 0.0001) in the very old group. However, there was no significant difference regarding the rate of surgical or medical complications, flap failure (middle aged group 43/791 flaps (5.44%) versus very old group 4/47 flaps (8.51%); P = 0.328), and revision rate (117/791 flaps (14.79%) versus 6/47 flaps (12.77%); P = 0.834) between the patient groups during our 3-months follow-up period.
  
  
  CONCLUSIONS
  Our findings suggest that despite higher rates of patient comorbidities, successful free tissue transfer can also be achieved in a very old population with acceptable risk for complications.
authors.affiliation: Department of Plastic, Reconstructive, Hand-, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany.
authors.forename: Paul I
authors.identifier: http://orcid.org/0000-0001-7885-8574
authors.initials: PI
authors.lastname: Heidekrueger
authors.affiliation: Department of Plastic, Reconstructive, Hand-, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Heine-Geldern
authors.affiliation: Department of Plastic, Reconstructive, Hand-, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany.
authors.forename: Milomir
authors.initials: M
authors.lastname: Ninkovic
authors.affiliation: Department of Plastic, Reconstructive, Hand-, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Herter
authors.affiliation: Department for Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar Technical University Hospital, Munich, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schmauss
authors.affiliation: Center of Plastic, Hand and Reconstructive Surgery, University Medical Center Regensburg, Germany.
authors.forename: Thiha
authors.initials: T
authors.lastname: Aung
authors.affiliation: Department of Plastic, Reconstructive, Hand-, and Burn Surgery, StKM-Klinikum Bogenhausen, Academic Teaching Hospital Technical University, Munich, Germany.
authors.forename: P Niclas
authors.initials: PN
authors.lastname: Broer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015897:Comorbidity; D005240:Feasibility Studies; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects / Q000637:transplantation*; D015577:Geriatric Assessment; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology