Free Flaps for Skin and Soft Tissue Reconstruction in the Elderly Patient: Indication or Contraindication

Abstract

Background: Increased lifespan and the improvement of medical treatment have given rise to research in reconstructive procedures in elderly patients. Higher postoperative complication rates, longer rehabilitation, and surgical difficulties remain a problem in the elderly. We asked whether a free flap in elderly patients is an indication or a contraindication and performed a retrospective, monocentric study. Methods: Patients were divided into two groups (YOUNG 0–59 years; OLD > 60 years). The endpoint was the survival of flaps and their dependence on patient- and surgery-specific parameters using multivariate analysis. Results: A total of 110 patients (OLD n = 59) underwent 129 flaps. The chance of flap loss increased as soon as two flaps were performed in one surgery. Anterior lateral thigh flaps had the highest chance for flap survival. Compared with the lower extremity, the head/neck/trunk group had a significantly increased chance of flap loss. There was a significant increase in the odds of flap loss in linear relation to the administration of erythrocyte concentrates. Conclusion: The results confirm that free flap surgery can be indicated as a safe method for the elderly. Perioperative parameters such as two flaps in one surgery and transfusion regimens must be considered as risk factors for flap loss.

Increased Patient Age as a Risk Factor Following Free Flap Reconstruction after Breast Cancer: A Single Institutional Review of 2,598 Cases

“…19 The safety of microsurgical reconstruction has been demonstrated across the spectrum of anatomical domains. 11,[20][21][22][23] Studies specific to age in ABR have yielded similar results. Selber et al analyzed 1,031 free flap breast reconstructions performed by a single surgeon and found similar rates of medical and surgical complications in patients >65 versus younger.…”

Free flap reconstruction of scalp in a case of advanced lung cancer with brain metastasis: A case report

“…The second factors were advanced age and comorbidities. [7–10] Although advanced age is not a contraindication for free flaps according to articles by Sorg et al [7] and Parsemain et al, [10] it is associated with surgical failure in several studies, including Fagin et al [9] In this case, the patient was under the age of 60 years, which was not deemed elderly. However, our patient had advanced lung cancer; therefore, tolerability to general anesthesia was a significant concern.…”

“…Although there are no documented contraindications for the free-flap procedure in patients with cancer with distant metastases, [7,8] it poses clinical challenges; however, there are only indications in elderly patients. Furthermore, there are no established contraindications for late-stage cancer.…”

“…Furthermore, there are no established contraindications for late-stage cancer. [7][8][9][10] In this case report, we encountered a patient with advanced lung cancer and brain metastasis who experienced wound healing failure. After a thorough evaluation of her risk factors, including hypercoagulable state, general condition, and survival expectancy, we performed free-flap reconstruction.…”