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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2021; 06(02): e87-e92
DOI: 10.1055/s-0041-1736419
Original Article

Safe Free Tissue Transfer in Patients Older than 90 Years

Marc H. Hohman
1   Department of Facial Plastic and Reconstructive Surgery, Madigan Army Medical Center, Tacoma, Washington
,
Aurora G. Vincent
2   Facial Plastic Surgery Associates, Fort Worth, Texas
,
Abdul R. Enzi
2   Facial Plastic Surgery Associates, Fort Worth, Texas
,
Yadranko Ducic
2   Facial Plastic Surgery Associates, Fort Worth, Texas
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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

Authors' Contributions

M.H.H. contributed to manuscript composition and literature review. A.G.V. contributed to manuscript composition and data analysis. A.R.E. contributed to literature review. Y.D. contributed to data collection and manuscript review.


Disclosures

The authors have no financial conflict to disclose. The work herein does not necessarily represent the views of the U.S. Army or Department of Defense.




Publication History

Received: 02 February 2021

Accepted: 31 May 2021

Article published online:
27 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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