Open Access Peer-reviewed

Success Rate of Free Flap Reconstructions in Elderly Patients

Merima Kasumović1, Vedran Uglešić2, Morena Milić3,

1Clinical Hospital Tuzla, Clinic for Plastic and Maxillofacial Surgery, Tuzla, Bosnia and Herzegovina

2Clinical Hospital Dubrava, Clinic for Maxillofacial Surgery, Zagreb, Croatia

3Clinical Hospital Dubrava, Clinic for Anesthesiology, Zagreb, Croatia

American Journal of Biomedical Research. 2013, 1(4), 71-74. DOI: 10.12691/ajbr-1-4-1
Published online: August 25, 2017

Abstract

There is much evidence that microvascular free flaps are successfully used in the reconstruction of the head and neck defects in cancer patients. It has become evident that proportional with ageing population, there is an increase in the number of elderly patients requiring microvascular reconstruction after radical excision of tumors in the head and neck region. The aim of this study is to estimate the correlation between the application of a microvascular free flap for defect reconstruction in elderly patients based on ASA (American Society of Anesthesiology) classification and postoperative surgical and medical morbidity. Study included 31 patients older than 70 years hospitalized in the period from 1996 to 2010 at the Clinic for Maxillofacial Surgery, Zagreb, Croatia. Base of reference for every patient included data about: gender, age, date and length of surgical procedure, basic diagnosis, chronic illneses, ASA (American Society of Anesthesiology) clasiffication, type of surgical procedure, type of microvascular free flap, postoperative complications, length of hospitalization and treatment results. Based on the data analysis it is estimated that morbidity was significantly higher in the number of male patients than the number of female patients (61% : 38.7%). Average age was 76 years and the oldest patient was 87 years old. According to ASA clasiffication patients were mostly ASA III (60,87%) and then ASA II 26.08%. Overall, the success rate of microvascular free flap was 94%. Moreover, postoperative medical complications were in the correlation with ASA status 19.45%. The study shows that the successs rate of microvascular free flap reconstruction of cancer in the head and neck region with elderly patients is directly related to ASA and the length of surgical procedure, as significant predictors in postoperative surgical and medical morbidity.

Keywords:

ASA clasiffication, microvascular free flap, radical surgical procedure, hemodynamic parameters
[1]  ARENA S, FISCHER M, HILL EY. Free tissue transfer in head and neck reconstruction. Am J Otolaryngol 1898: 10:110.View Article
 
[2]  KATSAROS J, SCHUSTERMAN MA, BEPPU M, BANIS JC, ACLAND ED (1984) The lateral upper arm flap: anatomy and clinical applications. Ann Plast Surg 12:489.View Article  PubMed
 
[3]  MUHLBACHER W, HERNDL E, STOCK W (1982) The forearm flap. Plast Reconstr Surg 70:336.View Article
 
[4]  LOWEN L, BOLIEK C, HARRIS J, SEIKALY H, RIEGER J (2009): Oral sensation and function: A comparison of patients with innervated radial forearm free flap reconstruction to healthy matched controls. Head Neck, Vol. 32, No.1. 85-95.
 
[5]  HARA I, GELLLRICH NC, DUKER J, SCHON R, FAKLER O, SCHMELZEISEN R,HONDA T, SATORU O (2003) Swallowing and speech function after intraoral soft tissue reconstruction with lateral upper arm free flap and radial forearm free flap. Br J Oral Maxillofac Surg 41:161.View Article
 
[6]  WEI F, JAIN V, SUOMINEN S, CHEN H (2001): Confusion among Perforator Flaps:What Is a True Perforator Flap? Plast Reconstr Surg Vol 107, No 3: 874-876.View Article  PubMed
 
[7]  WOOLF KD (1998) Indications of the vastus lateralis flap in oral and maxillofacial surgery. Br J Oral Maxillofac Surg 36:358.View Article
 
[8]  WEI F, MARDINI S (2004): Free-Style Free Flaps. Plast Reconstr Surg Vol 114, No 4: 910-915.View Article  PubMed
 
[9]  BEAUSANG ES, ANG EE, LIPA JE, IRISH JC, BROWN DH, GULLANE PJ, NELIGAN PC. Microvascular free tissue transfer in elderly patients: the Toronto experience. Head Neck. 2003: 25: 549-53.View Article  PubMed
 
[10]  BRIDGER AG, O BRIEN CJ, LEE KK. Advanced patient age should not preclude the use of free flap reconstruction for head and neck cancer. Am J Surg 1994: 168(5): 425-428.View Article
 
[11]  CHICK LR, WALTON RL, REUS W, et al. Free flaps in the elderly. Plast Reconstr Surg 1992: 90: 87-94.View Article  PubMed
 
[12]  DAVENPORT HT. Anesthetics and elderly patients: The new frontier. Br Med J 1991: 303:870.View Article  PubMed
 
[13]  FISCHER J. Microvascular reconstruction in the head and neck. Mayo Clin Proc 1986: 61:451.View Article
 
[14]  GOLDMAN L. Cardiac risks and complications of non cardiac surgery. Ann Intern Med 1983: 98:504.View Article  PubMed
 
[15]  GUARNIERI T, FILBURN C R, ZITNIK G et al. Constractil and Biochemical correlates of beta adrenergic stimulation of aged heart. Am J Physiol 1980: 239: H501. PubMed
 
[16]  INGLIS MS, ROBBIE DS, EDWARDS JM, BREACH NM. The anesthetic management of patients undergoing free flap reconstructive surgery following resection of head and neck neoplasm. A review of 64 cases. Ann R Coll Surg Engl 1988: 70: 235. PubMed
 
[17]  JOHNSON JT, RABUZZI DD, TUCKER HM. Composite resection in the elderly: a well tolerated procedure. Laryngoscope 1997: 87: 1509-1514.
 
[18]  KOBUS K, STEPNIEWSKI J. Free flaps versus conventional surgery. Ann Plast Surg 1985: 15:14.View Article  PubMed
 
[19]  MCGUIRT WF, LOEVY S, KRAUSE CJ. The risk of major head and neck surgery in the aged population. Laryngoscope 1997: 87: 1378-1382.
 
[20]  BONAWITZ SC, SCHNARRS RH, ROSENTHAL AI et all. Free tissue transfer in elderly patients. Plast Reconstr Surg: 1991: 87: 1074.View Article  PubMed
 
[21]  SEYMOUR DG, VAZ FG. A prospective study of elderly general surgical patients: Postoperative complications. Age Ageing 1989: 18:316.View Article  PubMed
 
[22]  SERLETTI J M, HIGGINS J P, MORAN S, ORLANDO G S. Factors Affecting Outcome in Free-Tissue Transfer in the Elderly. Plast Reconstr Surg: 2000: 106: 66-70.View Article  PubMed
 
[23]  SEYMOUR DG, VAZ FG. A prospective study of elderly general surgical patients: Postoperative complications. Age Ageing 1989: 18:316.View Article  PubMed