Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Asklepios Klinik North, Hamburg, Germany.
Clin Oral Investig. 2020 Jan;24(1):193-200. doi: 10.1007/s00784-019-02914-z. Epub 2019 May 8.
Increasingly, aging societies pose a challenge, particularly in the most developed countries. This trend leads to an increasing group of old and very old patients presenting unique requirements and challenges. One of these challenges consists in reassessment and adaption of established treatment strategies for the elderly patients. There is an ongoing discussion taking place among cranio-maxillo-facial surgeons about the appropriate extent of reconstructive flap surgery for old patients.
This monocentric retrospective cohort study investigated 281 reconstructions with microvascular flaps by comparing the risk for a negative outcome, which was defined as revision, flap loss, and patient death, between three subgroups of elderly patients and younger patients. The three subgroups of elderly patients were defined as-1: young old (65-74 years), 2: old (75-84 years), and 3: oldest old (≥ 85 years). The group of the younger patients was defined by age between 50 and 64 years. Data were obtained within a defined period of 42 months.
Significant correlations with a negative outcome were found for the variables stay on IMC/ICU, multiple flaps, and radiotherapy prior surgery. Our data showed no significant correlation between age and a higher risk for a negative outcome.
Defect reconstruction with microvascular flaps in old patients is not related with a higher risk for a negative outcome.
Independently of age, treatment with microvascular flaps is an option for all operable patients, with an indication for oncologic surgery. For optimal therapy planning, individual patient resources and preferences should be considered instead of chronologic age.
老龄化社会带来了挑战，尤其是在最发达的国家。这一趋势导致越来越多的老年和非常老年患者提出了独特的要求和挑战。其中一个挑战是重新评估和调整为老年患者制定的既定治疗策略。颅面外科医生正在讨论为老年患者进行适当范围的重建瓣手术。
本单中心回顾性队列研究通过比较 3 组老年患者和年轻患者的风险来研究 281 例微血管皮瓣重建的结果，该风险定义为修复、皮瓣丢失和患者死亡。老年患者分为三组：1：年轻老人（65-74 岁），2：老老人（75-84 岁），3：最老老人（≥85 岁）。年轻患者组的年龄定义为 50-64 岁。数据在 42 个月的规定期间内获得。
与不良结果显著相关的变量包括 ICU/IMC 停留时间、多个皮瓣和术前放疗。我们的数据显示，年龄与不良结果的高风险之间无显著相关性。
在老年患者中使用微血管皮瓣进行缺损重建与不良结果的高风险无关。
独立于年龄，使用微血管皮瓣治疗所有可手术患者是一种选择，只要有肿瘤手术的指征。为了进行最佳的治疗计划，应考虑患者的个体资源和偏好，而不是年龄。
