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

Area of Science:

• Reconstructive surgery
• Geriatric medicine
• Microsurgery

Background:

• Aging populations necessitate advanced reconstructive procedures.
• Elderly patients face higher risks of complications and longer recovery times in surgery.
• Free flap surgery in older adults requires careful evaluation as an indication versus contraindication.

Purpose of the Study:

• To evaluate the safety and efficacy of free flap surgery in elderly patients.
• To determine if advanced age is a contraindication for free flap procedures.
• To identify patient- and surgery-specific risk factors for flap loss in older individuals.

Main Methods:

• Retrospective, monocentric study design.
• Patients categorized into YOUNG (0-59 years) and OLD (>60 years) groups.
• Multivariate analysis to assess flap survival based on patient and surgical parameters.

Main Results:

• Free flap surgery was performed on 110 patients, with 59 in the OLD group.
• Performing two flaps in one surgery significantly increased flap loss risk.
• Anterior lateral thigh flaps demonstrated the highest survival rates.
• Head/neck/trunk reconstructions and erythrocyte concentrate administration were associated with higher flap loss rates compared to lower extremity reconstructions.

Conclusions:

• Free flap surgery is a viable and safe option for elderly patients.
• Perioperative factors, including the number of flaps and transfusion requirements, are critical risk factors for flap loss.
• Careful consideration of surgical strategy and transfusion management can optimize outcomes in geriatric reconstructive surgery.