Is there any chance for microsurgical reconstructions in elderly?

In Italy there is a increase in the percentage of population aged over 70 with a gradual increase in average life expectancy (Table 1).

Table 1 Mean of average life expectancy

Some studies show that septuagenarians have a greater chance of survival than octogenarians postoperatively and a lower incidence of mortality perioperatively [1].

Recent studies show that elderliness is not an independent risk factor for microsurgical complications, but it is related to increased incidence of medical complications, particularly in patients with more 'comorbidities' and with a higher American Society of Anesthesiologists status [2]. The need of considering some important aspects during the preoperative phase is important in evaluation of an elderly to be subjected to a microsurgical operation.

These factors are: prolonged operation time due to microsurgical anastomosys; donor site morbidity; condition of recipient vessels. In order to satisfy these criteria, some therapeutic devices could be advanced such as perioperative prophylactic anticoagulation [3].

The indications for microvascular free-tissue transfers (MFTT) in the elderly are different from those in the young: post car-traumas are treated in lower extremity, risks to which an elderly is less exposed. Moreover they are not common operations because elderly vessels are more affected by vascular diseases; in trunk, elderly rarely requires reconstruction. MFTT made in head-neck district are the same in percentage as the ones made on the young: if we have a loss of tissue, reconstruction must be immediate in both. Moreover the recipient vessels are less affected by atherosclerosis than peripheral vessels .The percentage of surgical complications is equal in both.

Conclusions

The limit in MFTT on an elderly patient is notimposed by the technique used but by the request of the patient and by the status of his vessels. If a patient’s medical problem doesn’t represent a handicap, MFTT can be safely performed in the elderly by using proper techniques and precautions.