Howard Michael A, Cordeiro Peter G, Disa Joseph, Samson William, Gonen Mithat, Schoelle Robin N, Mehrara Babak
Department of Surgery, and Biostatistics Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Plast Reconstr Surg. 2005 Nov;116(6):1659-68; discussion 1669-71. doi: 10.1097/01.prs.0000187135.49423.9f.
There are an increasing number of elderly patients requiring free tissue transfer. The risks of complex reconstructions in this patient population remain largely unknown. Therefore, the authors' reason for conducting this study was to review their experience with free tissue transfer in patients aged 70 years or older.
A retrospective review of all free tissue transfers performed over a 10-year period at Memorial Sloan-Kettering Cancer Center was performed and all patients aged 70 years or older were identified. Medical records and the authors' prospectively maintained database were analyzed with respect to comorbidities and postoperative complications.
Two hundred eleven patients aged 70 years or older (70 to 79 years, n = 184; 80+ years, n = 27) were identified during the study period. Of these, 197 (70 to 79 years, n = 170; 80+ years, n = 27) patients had complete charts for review. Flap survival was 100 percent in the 80+ group and 97 percent in the 70 to 79 group. The overall complication rate was 59.3 percent in the 80+ group and 35.3 percent in the 70 to 79 group (p = 0.030). The medical complication rate was 40.7 percent in octogenarians and 11.8 percent in septuagenarians (p = 0.0004). Overall surgical complications were similar in the two groups. Univariate analysis demonstrated that age was associated with medical complications but not surgical complications. Using multivariate analysis, the authors found that alcohol use and coronary artery disease were independent predictors of overall, medical, and surgical complications.
Free tissue transfer may be performed in patients over age 70 with a high degree of technical success. The procedure, however, carries a distinct risk of perioperative mortality and morbidity, particularly in patients over the age of 80. Comorbidities significantly associated with complications include age, alcohol use, coronary disease, and hypertension. This study suggests that prolonged survival may be achieved in some patients; however, a selective approach is required.
需要进行游离组织移植的老年患者数量日益增多。在这一患者群体中进行复杂重建手术的风险在很大程度上仍不为人所知。因此，作者开展这项研究的目的是回顾他们在70岁及以上患者中进行游离组织移植的经验。
对纪念斯隆凯特琳癌症中心在10年期间进行的所有游离组织移植手术进行回顾性研究，并确定所有70岁及以上的患者。分析病历以及作者前瞻性维护的数据库，了解合并症和术后并发症情况。
在研究期间确定了211例70岁及以上的患者（70至79岁，n = 184；80岁及以上，n = 27）。其中，197例（70至79岁，n = 170；80岁及以上，n = 27）患者有完整病历可供审查。80岁及以上组的皮瓣存活率为100%，70至79岁组为97%。80岁及以上组的总体并发症发生率为59.3%，70至79岁组为35.3%（p = 0.030）。八旬老人的医疗并发症发生率为40.7%，七旬老人为11.8%（p = 0.0004）。两组的总体手术并发症相似。单因素分析表明，年龄与医疗并发症相关，但与手术并发症无关。通过多因素分析，作者发现饮酒和冠状动脉疾病是总体、医疗和手术并发症的独立预测因素。
70岁以上患者进行游离组织移植可取得较高的技术成功率。然而，该手术有明显的围手术期死亡率和发病率风险，尤其是80岁以上的患者。与并发症显著相关的合并症包括年龄、饮酒、冠心病和高血压。这项研究表明，一些患者可能实现延长生存期；然而，需要采取选择性方法。
