Abstract
Objective This study aimed to evaluate the safety of microvascular free tissue transfer in
the elderly patient population.
Methods We performed a 20-year retrospective review at a tertiary care private practice of
patients of ≥ 90 years of age who underwent microvascular free tissue transfer and
had at least 6 months of follow-up. Similarly, we reviewed patients aged 70 to 89
years who underwent free tissue transfer between 2018 and 2020 as a control group.
Records were examined for type of flap, defect site, pathology, and occurrence of
complications.
Results Overall 77 patients of 90 years or older met the inclusion criteria and 77 sequential
patients aged 70 to 89 years were identified to serve as a control group. The overall
complication rate among patients of ≥ 90 years of age was 18%, with flap-related complications
in 4% (two partial flap loss and one total loss). The mortality rate was 1.3%. All
patients of ≥ 90 years of age undergoing osteocutaneous reconstruction for osteoradionecrosis
experienced complications, but only one was a flap complication (partial loss). Among
patients aged 70 to 89 years, the overall complication rate was also 18%, with flap-related
complications in 4% (two complete flap failures and one partial loss). The mortality
rate in the control group was 2.6%.
Conclusion Soft tissue free flaps are a safe option in the elderly patient population and should
be offered to patients who are medically optimized prior to surgery, regardless of
age. Osteocutaneous reconstruction for osteoradionecrosis must be undertaken with
caution. This study reflects level of evidence 4.
Keywords
free tissue transfer - elderly - osteoradionecrosis - cancer - complications
