Head and neck free-flap reconstruction in the elderly

Objective: To evaluate the reliability of free-flap head and neck reconstruction in the elderly. Material and methods: All patients who underwent free-flap head and neck reconstruction in our institution between 2000 and 2010 were included in this retrospective study. In all, 418 patients (301 men and 117 women) were enrolled, including 95 patients aged 70 years or older (mean age = 60.2 +/- 11.6 years). The impact of age on free-flap failure and local and general complication rates was assessed on univariate and multivariate analysis. Results: Advanced age had no impact on free-flap failure and local complications rate but was correlated with a higher risk of general complications (multivariate analysis: P = 0.007). A high level of comorbidity also had a significant impact on the general complications rate (multivariate analysis: P = 0.001). Patients who underwent circular total pharyngolaryngectomy showed elevated risk of free-flap failure (P = 0.005) and local complications (P = 0.001) on multivariate analysis. Conclusion: Free-flap reconstruction of the head and neck is safe and reliable in the elderly. Nevertheless, meticulous patient selection, mainly based on the level of comorbidity, is necessary. (C) 2010 Elsevier Masson SAS. All rights reserved.