Microsurgical reconstructive surgery in patients aged 80 years or older

Microsurgical reconstruction using free flaps in elderly patients has increased in recent years. Between April 1981 and December 2001, 34 patients aged 80 years or older underwent reconstruction at our hospitals using free flaps for head and neck defect. Preoperative medical complications concerning cardiac, pulmonary and renal function were recognized in more than half of the 34 patients. Severe arteriosclerotic changes in the recipient artery were recognized in 4 patients. Among them, one flap failed due to arterial thrombosis that occurred two days postoperatively. Major medical postoperative complications developed in 5 patients. These included two cases of renal failure, two cases of pneumonia and respiratory insufficiency, and one case of cerebral vascular accident. Four of these patients died, so the surgical mortality rate was 11.8% (4/34). Advanced age does not affect the technical success of microsurgical free tissue transfer, but the risk of medical complications is significant and directly related to concurrent illness of the individual patient rather than to age alone.