Summary
Background
Though technically feasible, free tissue transfer carries the risk of perioperative
morbidity and mortality in elderly patients. To minimize the operative treatment time
and complication rates, we choose the rectus abdominis muscle (RAM) flap.
Methods
Between 2012 and 2017, 34 patients (mean age: 74±7 years, range: 65–89 years) with
comorbidities underwent defect reconstruction with a free RAM flap. Recipient-sites
were: lower extremity (65%), trunk (18%), upper extremity (12%), and head and neck
(6%).
Results
The ASA status was 2 in 11 patients, 3 in 21 patients, and 4 in 2 patients. Twenty
patients (59%) received additional vascular surgery. Three patients (9%) underwent
simultaneous restoration of fractures. The mean operative time (OT) was 325±75 min.
There was no total flap loss. Partial flap loss occurred in one patient (3%). The
incidence of surgical and medical complications was 32% and 38%: 11 patients experienced
a total of 22 surgical complications, of which 15 were major (requiring additional
surgery) and 7 minor (conservative treatment). One patient died postoperatively because
of progressive respiratory failure. Prolonged OT was highly associated with hematoma
formation requiring re-operation (p = 0.01). ASA status was a significant predictor for postoperative critical care monitoring
(p = 0.03). Reconstruction was successful in 31 out of 34 patients (91%) during a mean
follow-up time of 17.7 ± 8.8 months (range: 2–51 months).
Conclusion
The free RAM flap has proven as a reliable and efficient tool in the armamentarium
of reconstructive microvascular surgeons with some advantages in the treatment of
multimorbid patients older than 65 years.
Keywords
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Article info
Publication history
Published online: January 11, 2019
Accepted:
January 6,
2019
Received:
October 21,
2018
Identification
Copyright
© 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
