Free-tissue transfer in elderly patients

A retrospective survey was undertaken to evaluate the success of free-tissue transfer (free flap) in the elderly. During a 70-month period, 199 free flaps were performed in 151 patients at the Western Pennsylvania Hospital, 60 of these involving 47 patients over the age of 60. Primary coverage rates differed significantly between the elderly and younger age groups (68.5 versus 85.3 percent, respectively); however, eventual coverage rates (92.6 versus 96.3 percent), minor complication rates (34.0 versus 34.6 percent), mortality rates (2.1 versus 1.0 percent), flap revision rates (32 percent of patients versus 30 percent), and length of postoperative hospitalization (18.7 versus 18.8 days) were not significantly different in the two groups. Among the elderly, significant increases in flap loss rates were noted with the use of end-to-side arterial anastomosis, placement of the anastomosis within a zone of injury, and the use of the gracilis muscle donor site. Our data suggest that the primary cause of free-flap failure is construction of the anastomosis within a zone of injury. Free-tissue transfer is a valuable option in the repair of tissue defects in the elderly and should not be denied as a treatment because of patient age.