Outcomes of free flap reconstruction in the elderly

Abstract

The reconstructive surgeon is often faced with the dilemma of offering free flap reconstruction to the elderly after surgical extirpation in the head and neck due to the perception that this population tolerates these procedures poorly. A 42-month retrospective review of all microvascular free flap reconstruction cases from a large head and neck oncology program was reviewed. A series of 278 patients met inclusion criteria and were stratified into 2 age groups: 45 to 64.9 years (n = 177) and ≥65 years (n = 101). There was no significant difference in primary outcomes, anastomotic compromise (p = .36), unsalvageable flaps (p = .46), secondary outcomes, complicated recoveries (p = .29), or deaths within 30 days of surgery (p = .14) between the 2 groups. However, the length of postoperative recovery was increased in the elderly cohort (p = .029). Given that outcomes were similar between young and elderly patients, surgeons should not restrict the use of free flaps based on their patients' age.