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Microvascular free tissue transfer in elderly patients: The Toronto experience

Authors

  • Eamon S. Beausang MD, FRCSI(Plast),

    1. Division of Plastic and Reconstructive Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
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  • Erik E. Ang MB, FRCS(Edin),

    1. Division of Plastic and Reconstructive Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
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  • Joan E. Lipa MD, FRCSC,

    1. Division of Plastic and Reconstructive Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
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  • Jonathan C. Irish MD, FRCSC, FACS,

    1. Head and Neck Program, Toronto General Hospital, University of Toronto, Eaton Wing 7-229, 230 Elizabeth Street, Toronto, Ontario, M5G 2C4 Canada
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  • Dale H. Brown MD, FRCSC, FACS,

    1. Head and Neck Program, Toronto General Hospital, University of Toronto, Eaton Wing 7-229, 230 Elizabeth Street, Toronto, Ontario, M5G 2C4 Canada
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  • Patrick J. Gullane MB, FRCSC, FACS,

    1. Head and Neck Program, Toronto General Hospital, University of Toronto, Eaton Wing 7-229, 230 Elizabeth Street, Toronto, Ontario, M5G 2C4 Canada
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  • Peter C. Neligan MB, BCh, FRCS(I), FRCSC, FACS

    Corresponding author
    1. Division of Plastic and Reconstructive Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
    • Division of Plastic and Reconstructive Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
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  • Presented at the American Society for Reconstructive Microsurgery 16th Annual Meeting, San Diego, January 2001.

Abstract

Background.

Microvascular free tissue transfer has become an accepted and versatile method of reconstruction in the head and neck region, offering a one-stage procedure and thus reducing the number and length of hospital stays. Many of the patients requiring head and neck free flaps are elderly, with concomitant medical problems, including respiratory and cardiovascular compromise, and are therefore potentially at higher risk of adverse outcomes. In addition, they frequently have a history of heavy alcohol and cigarette consumption, which can compound the risks.

Methods.

We analyzed a series of 288 intraoral free flap reconstructions and arbitrarily divided them into four groups depending on age: <50, 51–60, 61–70, >70. These reconstructions were all performed for malignant lesions. Preoperative medical problems, including ischemic heart disease, hypertension, chronic obstructive pulmonary disease, peripheral vascular disease, and diabetes, were assessed and compared among the different age groups.

Conclusions.

Our results suggest that free flap surgery is a safe technique in elderly patients with comparable surgical complications to a younger patient population. As a result of concomitant medical problems, however, postoperative medical complications are more frequent in the older age groups, with a resultant increase in length of hospital stay. © 2003 Wiley Periodicals, Inc. Head Neck 25: 549–553, 2003

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