Success Rate of Free Flap Reconstructions in Elderly Patients

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.