Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
Department of Plastic and Reconstructive Surgery, Aesthetic Surgery Center, Union Hospital, Huazhong University of Science and Technology, Wuhan, P.R. China.
J Reconstr Microsurg. 2020 Feb;36(2):127-135. doi: 10.1055/s-0039-1697646. Epub 2019 Sep 23.
In elderly patients, complex soft tissue defects are increasingly observed due to the prolonged life expectancy and accompanying comorbidities. The aim of this study is to evaluate whether free tissue transfer is safe in very old patients without additional risk and complications.
All patients older than 65 years undergoing free tissue transfer between November 2007 and September 2016 were reviewed in a retrospective study. Two cohorts were compared regarding perioperative morbidity and postoperative outcome (cohort 1 [old patients, ages 65-79]; cohort 2 [very old patients, ages ≥ 80]).
In total, 256 patients were included in the study (cohort 1 [ = 217]; cohort 2 [ = 39]). Overall, 262 free flaps were performed due to a second microsurgical reconstruction in six cases. No statistically significant differences between cohorts were observed regarding surgical complications, total flap losses, and mortality. Detailed evaluation of cohort 2 revealed a significant learning curve during the observation period regarding the perioperative management and procedure of soft tissue reconstruction: operation length as well as postoperative intensive care unit stay decreased significantly over time ( < 0.05) and also surgical complications showed a positive trend ( = 0.07). We ascertained a shift toward a "more reliable" flap selection from predominantly anterolateral thigh flap) to axial flaps such as rectus abdominis and latissimus dorsi flaps.
Our study showed that age is not associated with an increased risk of postoperative complications. Reliable muscle free flaps, two-stage procedures, and safe vascular supply are important strategic aspects to achieve microvascular tissue transfer with high success rates in geriatric patients.
由于预期寿命延长和伴随的合并症，老年患者中越来越多地出现复杂的软组织缺损。本研究旨在评估在没有额外风险和并发症的情况下，非常老年患者行游离组织移植是否安全。
回顾性研究分析了 2007 年 11 月至 2016 年 9 月期间行游离组织移植的所有年龄大于 65 岁的患者。比较了两组患者的围手术期发病率和术后结果（年龄 65-79 岁的老年患者为组 1；年龄≥80 岁的非常老年患者为组 2）。
共有 256 例患者入组（组 1 [ = 217]；组 2 [ = 39]）。由于 6 例患者需要第二次显微重建，因此共进行了 262 次游离皮瓣手术。两组患者在手术并发症、总皮瓣失活和死亡率方面无统计学差异。对组 2 的详细评估显示，在观察期间，软组织重建的围手术期管理和手术过程存在明显的学习曲线：手术时间和术后重症监护病房停留时间随时间推移显著缩短（ < 0.05），手术并发症也呈积极趋势（ = 0.07）。我们发现，游离皮瓣的选择从主要的股前外侧皮瓣逐渐向更可靠的轴型皮瓣（如腹直肌皮瓣和背阔肌皮瓣）转变。
本研究表明，年龄与术后并发症风险增加无关。可靠的肌皮瓣、两阶段手术和安全的血管供应是在老年患者中实现高成功率的微血管组织移植的重要策略。
