JAMA Otol Logo Orlando 2013 AHNS Meeting Location
American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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Presentation: S004
Topic: Clinical - Plastic & Reconstructive Surgery
Type: Oral Presentation
Date: Wednesday, April 10, 2013
Session: 01:30 PM - 02:30 PM Reconstruction / Oropharynx / HPV
Authors: Jacob L Wester, BS, Amy Pittman, MD, Robert H Lindau, MD, Mark K Wax, MD
Institution(s): Oregon Health and Science University

Objectives: Several studies have shown excellent reconstructive outcomes using free tissue transfer in elderly patients. These studies, however, are limited in size and few describe long term donor site morbidity. The purpose of our study is to assess donor site morbidity after fasciocutaneous free tissue transfer in patients 70 years and older.

Methods: Patients were identified from 2002-2011 at a tertiary-care center who were over 70 years of age and had fasciocutaneous free flap reconstruction of the head and neck. Donor sites included; radial forearm (RFFF), ulnar forearm (UFFF) and anterolateral thigh (ALT). 171 younger patients from the same time period were randomly selected to act as controls. Demographic, surgical and clinical data were extracted from the electronic medical record. Donor site morbidity was compared between the two groups.

Results: 622 fasciocutaneous free flaps were performed during the study period. 158 (25.4%) flaps were performed on patients 70 years and older, with a median age of 77 years (70-92). There were 100 RFFF, 9 UFFF, and 49 ALT flaps performed. The median paddle size was 64 cm2 and median follow up time was 10 months. Overall donor site morbidity in patients 70 years and older was 22.2% vs. 25.2% in patients less than 70 years, p=0.6. Infection was the most common morbidity in the elderly (8.9%) and was not significantly different from younger patients (9.4%), p=0.84. Complete loss of STSG (6.2% vs. 2.9%, p=0.34), forearm tendon exposure (7.1% vs. 3.9%, p=0.38), extremity numbness (4.7% vs. 3.2%, p=0.57) and seroma (5.2% vs. 2.5%, p=0.26) were not significantly different.

Conclusion: Donor site morbidity may be expected in up to 1 of 4 patients after fasciocutaneous free tissue transfer. Age over 70 years does not increase this risk.

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