Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Switzerland.
Medical Directorate, Medical Controlling, University Hospital Zurich, Switzerland.
J Plast Reconstr Aesthet Surg. 2016 Aug;69(8):1017-23. doi: 10.1016/j.bjps.2016.01.020. Epub 2016 Feb 3.
Population aging strongly affects the demographic development of industrialized countries. While microsurgical procedures were initially believed to be only feasible in patients of younger age because of the duration of the surgical procedure and the higher risk of vascular insufficiency due to age-related comorbidities, it has become evident that these procedures are beneficial even for patients at an advanced age.
We retrospectively investigated microsurgical procedures in a patient cohort (n = 25 with 27 free flaps) with a minimum age of 78 years with regard to patients' characteristics, flap survival, and postoperative surgical and medical complications.
Median age was 81 years (IQR 6). Most defects were located in the head and neck region. The mean operation time was 384 min (standard deviation (SD) 131). Flap failure was observed in three cases (11%). The median length of hospital stay was 17 days (interquartile range (IQR) 8). The mean ASA score was 2.48. Patients' age and ASA group did not correlate. The mortality rate was 4%. Postoperative surgical complications were observed in 11 cases (41%), while 19 patients (70%) showed one or more medical complications. Higher ASA classes tended to show more postoperative complications. However, neither age nor operating time nor ASA status showed significant influence on the occurrence of postoperative medical or surgical complications.
There is growing demand for structural and functional restoration using free tissue transfer in an aging population. If there are no alternative treatment options available promising similar structural and functional preservation, free tissue transfer is justifiably in very old patients despite a potentially increased flap failure. As such, free tissue transfer is used as a curative treatment concept aiming at a maximum of patients' independence and early ambulation. Occurrence of complications can be diminished by adequate patient selection and thorough perioperative care.
人口老龄化强烈影响工业化国家的人口发展。虽然最初认为显微外科手术仅适用于年轻患者，因为手术持续时间较长，并且由于与年龄相关的合并症导致血管不足的风险较高，但显然这些手术对高龄患者也有益。
我们回顾性研究了 25 例患者（27 个游离皮瓣）的显微外科手术，这些患者的最小年龄为 78 岁，研究内容包括患者特征、皮瓣存活率以及术后手术和医疗并发症。
中位年龄为 81 岁（IQR 6）。大多数缺陷位于头颈部。平均手术时间为 384 分钟（标准差 131 分钟）。有 3 例（11%）出现皮瓣失败。中位住院时间为 17 天（IQR 8）。平均 ASA 评分为 2.48。患者年龄和 ASA 组之间没有相关性。死亡率为 4%。11 例（41%）发生术后手术并发症，19 例（70%）出现 1 种或多种医疗并发症。较高的 ASA 分级往往会出现更多的术后并发症。然而，年龄、手术时间或 ASA 状态均未对术后医疗或手术并发症的发生产生显著影响。
在老龄化人口中，对使用游离组织转移进行结构和功能重建的需求日益增长。如果没有其他治疗选择具有类似的结构和功能保留效果，那么在没有其他治疗选择的情况下，尽管皮瓣失败的风险可能增加，但游离组织转移在非常高龄的患者中也是合理的。因此，游离组织转移被用作一种治疗概念，旨在使患者最大程度地独立并尽早行走。通过适当的患者选择和全面的围手术期护理，可以减少并发症的发生。
