Surgical outcomes in the elderly patient after osteocutaneous free flap transfer.

OBJECTIVES/HYPOTHESIS: Morbidity of free tissue transfer in the elderly patient is controversial. Recent studies have shown no significant difference in elderly fasciocutaneous free-flap donor site morbidity. The purpose of this study is to assess surgical outcomes in elderly patients receiving osteocutaneous free-tissue transfer.

STUDY DESIGN: Retrospective chart review of patients 70 years and older undergoing osteocutaneous free flaps from 2000 to 2013.

METHODS: Fibular, radial forearm, and scapular flaps were reviewed. Younger patients randomly selected from the same time period served as controls. Data collected included donor site morbidity, flap complications, feeding tube and tracheostomy dependence, and hospital stay.

RESULTS: Forty-four osteocutaneous free flaps were performed in elderly patients. Overall, there was no significant difference in donor site morbidity between older and younger patients (P = 0.50) (tendon exposure, P = 1.00; split-thickness skin graft loss, P = 0.36; infections, P = 0.52; dehiscence, P = 1.00; and seroma, P = 1.00). There was no significant difference between older and younger patients being decannulated (P = 0.61) or the time to decannulation (P = 0.24). There was no difference in those who returned to baseline diet (P = 0.67). All patients returned to baseline ambulatory and shoulder status. Length of postoperative hospitalization (P = 0.78) and intensive care unit stay (P = 0.94) were also equal. The only significant difference was that more elderly patients were discharged to skilled nursing facilities (SNF) (40.9% vs. 15.9%, P < 0.01).

CONCLUSION: Elderly patients undergoing free tissue transfer have similar flap and donor site outcomes, feeding tube and tracheostomy outcomes, ambulatory status, and hospital stays compared to younger patients. They are, however, more likely to require SNF care posthospitalization.

LEVEL OF EVIDENCE: 4.