gms | German Medical Science

First world’s population is an aging society. Health care systems have to face the consequences of this demographic change by applying current concepts of medical treatment onto a broadened age spectrum. While microsurgical procedures were initially believed to be only feasible in patients of younger age related to the long operation time, preexistent comorbidities with reduced organ reserves and decreased compliance of the senile patient, it has become evident during the last decades, that these procedures have their merit even in patients at an advanced age. We retrospectively investigated the role of microsurgical procedures in a senile patient cohort with a minimum age of 78 years. Concerned medical files were reviewed for patients’ characteristics, procedure specific details, flap survival and postoperative surgical and medical complications. Potential influence of age, operation time and ASA classification on the outcomes (flap survival, mortality, medical and surgical complications) was investigated.

Median age was 81 ± 6 years (78 – 96). Most defects were located on the head due to radical tumor resections. Mean operation time was 384 ± 139 min (170 – 645). Median length of hospital stay was 17 ± 8 days (8 – 49). Most patients were classified ASA class II (56%) with an overall mean ASA score of 2.48 ± 0.77. Patients’ age and ASA group were not correlated. Mortality rate was 4%. Overall flap survival rate was 88.9%. Postoperative surgical complications were observed in 40.7%, while 70.4% showed one or more medical complication. Higher ASA classes tended to show more postoperative complications. Neither age, nor operating time, nor ASA status showed statistical significant influence on flap survival or the occurrence of postoperative medical or surgical complications.

Microsurgical free tissue transfer is a growingly demanded treatment concept in our aging population. Despite a somewhat reduced flap survival rate, free flap transfer is a feasible therapeutic option even for patients at an advanced age. Occurrence of complications can be diminished by adequate patient selection and thorough perioperative care.