Efficacy of free flap reconstruction of the head and neck in patients 90 years and older

Objective: To determine the efficacy of free flap reconstruction in patients 90 years and older. Design: Retrospective medical chart review. Setting: Academic medical center. Patients: Patients 90 years and older who underwent a free flap reconstruction from 2002 through 2011 were identified. Main Outcome Measures: Clinical, demographic, and procedural data were recorded. Complications of surgery were either medical or flap related. Long-term follow-up was recorded to determine late flap complications, donor site morbidity, and functional outcomes. Results: Of 847 free flaps, 10 (1.2%) were performed in patients 90 years and older, with a median follow-up time of 8.5 months. Four medical complications (40%) occurred (1 case of pneumonia and 3 cases of arrhythmia). There were no mortalities. Two recipient site complications (20%) occurred (1 infection and 1 fistula). The flap failure rate was 0%. One late complication developed 7 months postoperatively involving infection and nonunion of the mandibular reconstruction. There was donor site morbidity in 1 patient. Functional status returned to baseline in 8 patients (80%) at the last follow-up visit. Conclusions: Medical and flap-related complications in patients 90 years and older are consistent with rates previously reported in elderly patients. Furthermore, patients 90 years and older can tolerate free flap reconstruction with favorable long-term outcomes.