scholarly journals Safe Free Tissue Transfer in Patients Older than 90 Years

2021 ◽  
Vol 06 (02) ◽  
pp. e87-e92
Author(s):  
Marc H. Hohman ◽  
Aurora G. Vincent ◽  
Abdul R. Enzi ◽  
Yadranko Ducic
Keyword(s):  
Elderly Patient ◽  
Mortality Rate ◽  
Complication Rate ◽  
Patient Population ◽  
Tertiary Care ◽  
Free Tissue Transfer ◽  
The Elderly ◽  
Control Group ◽  
Partial Loss ◽  
Tissue Transfer

Abstract Objective This study aimed to evaluate the safety of microvascular free tissue transfer in the elderly patient population. Methods We performed a 20-year retrospective review at a tertiary care private practice of patients of ≥ 90 years of age who underwent microvascular free tissue transfer and had at least 6 months of follow-up. Similarly, we reviewed patients aged 70 to 89 years who underwent free tissue transfer between 2018 and 2020 as a control group. Records were examined for type of flap, defect site, pathology, and occurrence of complications. Results Overall 77 patients of 90 years or older met the inclusion criteria and 77 sequential patients aged 70 to 89 years were identified to serve as a control group. The overall complication rate among patients of ≥ 90 years of age was 18%, with flap-related complications in 4% (two partial flap loss and one total loss). The mortality rate was 1.3%. All patients of ≥ 90 years of age undergoing osteocutaneous reconstruction for osteoradionecrosis experienced complications, but only one was a flap complication (partial loss). Among patients aged 70 to 89 years, the overall complication rate was also 18%, with flap-related complications in 4% (two complete flap failures and one partial loss). The mortality rate in the control group was 2.6%. Conclusion Soft tissue free flaps are a safe option in the elderly patient population and should be offered to patients who are medically optimized prior to surgery, regardless of age. Osteocutaneous reconstruction for osteoradionecrosis must be undertaken with caution. This study reflects level of evidence 4.

scholarly journals Descending necrotizing mediastinitis in the elderly patients

Open Medicine ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. 449-460 ◽  
Author(s):  
Antonio Mazzella ◽  
Mario Santagata ◽  
Atirge Cecere ◽  
Ettore La Mart ◽  
Alfonso Fiorelli ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Mortality Rate ◽  
Elderly Patients ◽  
High Mortality ◽  
Patient Population ◽  
The Elderly ◽  
Therapeutic Management ◽  
Descending Necrotizing Mediastinitis ◽  
Long Time

AbstractDescending Necrotizing Mediastinitis (DNM) is a polymicrobic, dangerous and often fatal process, arising from head or neck infections and spreading along the deep fascial cervical planes, descending into the mediastinum. It can rapidly progress to sepsis and can frequently lead to death. It has a high mortality rate, up to 40% in the different series, as described in the literature. Surgical and therapeutic management has been discussed for long time especially in an elderly patient population. The literature has been reviewed in order to evaluate different pathogenesis and evolution and to recognise a correct therapeutic management.

Analysis of the elderly patient population in a tertiary-care university hospital

2009 ◽  
Vol 18 (3) ◽  
pp. 264-270 ◽  
Author(s):  
A. JUÁREZ ◽  
J. GARDE ◽  
C. CABALLERO ◽  
V. IRANZO ◽  
J. GAVILÁ ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Patient Population ◽  
Tertiary Care ◽  
The Elderly ◽  
University Hospital

scholarly journals Long-term results of microvascular free-tissue transfer reanimation of the paralyzed face: Three cases

2008 ◽  
Vol 87 (4) ◽  
pp. 226-233
Author(s):  
John P. Leonetti ◽  
Chad A. Zender ◽  
Daryl Vandevender ◽  
Sam J. Marzo
Keyword(s):  
Facial Nerve ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Free Tissue Transfer ◽  
Long Term Results ◽  
Wide Field ◽  
Facial Movement ◽  
Tissue Transfer ◽  
Facial Reanimation

We conducted a retrospective case review at our tertiary care academic medical center to assess the long-term results of microvascular free-tissue transfer to achieve facial reanimation in 3 patients. These patients had undergone wide-field parotidectomy with facial nerve resection. Upper facial reanimation was accomplished with a proximal facial nerve–sural nerve graft, and lower facial movement was achieved through proximal facial nerve–long thoracic (serratus muscle) nerve anastomosis. Outcomes were determined by grading postoperative facial nerve function according to the House-Brackmann system. All 3 patients were able to close their eyes independent of lower facial movement, and all 3 had achieved House-Brackmann grade III function. We conclude that reanimating the paralyzed face with microvascular free-tissue transfer provides anatomic coverage and mimetic function after wide-field parotidectomy. Synkinesis is reduced by separating upper-and lower-division reanimation.

Propofol Versus Midazolam/Fentanyl Sedation for Colonoscopy in the Elderly Patient Population

2017 ◽  
Vol 32 (3) ◽  
pp. 210-214 ◽  
Author(s):  
Pamela Lovett ◽  
Victoria Gómez ◽  
David O. Hodge ◽  
Beth Ladlie
Keyword(s):  
Elderly Patient ◽  
Patient Population ◽  
The Elderly

scholarly journals Liver and Pancreatic Resection in the Elderly

HPB Surgery ◽  
1997 ◽  
Vol 10 (4) ◽  
pp. 259-261 ◽  
Author(s):  
O. J. Garden
Keyword(s):  
Survival Rate ◽  
Liver Resection ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Complication Rate ◽  
Pancreatic Resection ◽  
The Elderly ◽  
Term Survival ◽  
Pancreatic Resections

Background: Liver resection, or pancreaticoduodenectomy, has traditionally been thought to have a high morbidity and. mortality rate among the elderly. Recent improvements in surgical and anesthetic techniques, an increasing number of elderly patients, and an increasing need to justify use of limited health care resources prompted an assessment of recent surgical outcomes.Methods: Five hundred seventy-seven liver resections (July 1985–July 1994) performed for metastatic colorectal cancer and 488 pancreatic resections (October 1983–July 1994) performed for pancreatic malignancies were identified in departmental data bases. Outcomes of patients younger than age 70 years were compared with those of patients age 70 years or older.Results: Liver resection for 128 patients age 70 years or older resulted in a 4% perioperative. mortality rate and a 42% complication rate. Median hospital stay was 13 days, and 8% of the patients required admission to the intensive care unit (ICU). Median survival was 40 months, and the 5-year survival rate was 35%. No difference were found between results for the elderly and those for younger patients who had undergone liver resection, except for a minimally shorter hospital stay fortheyoungerpatients (median, 12 days vs. 13 days p=0.003). Pancreatic resection for 138 elderly patients resulted in a mortality rate of 6% and a complication rate of 45%. Median stay was 20 days, and 19% of the patients required ICU admission, results identical to those for the younger cohort. Long-term survival was poorer for the elderly patients, with a 5-year survival rate of 21% compared with 29% for the younger cohort (p=0.03).Conclusions: Major liver or pancreatic resections can be performed for the elderly with acceptable morbidity and mortality rates and possible long-term survival. Chronologic age alone is not a contraindication to liver or pancreatic resection for malignancy.

scholarly journals One-year postoperative mortality rate among the elderly with hip fractures at a single tertiary care center

2020 ◽  
Vol 40 (4) ◽  
pp. 298-304
Author(s):  
Khalid A. Alsheikh ◽  
Firas M. Alsebayel ◽  
Faisal Abdulmohsen Alsudairy ◽  
Abdullah Alzahrani ◽  
Ali Alshehri ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Mortality Rate ◽  
Hip Fractures ◽  
Surgical Intervention ◽  
Care Center ◽  
Tertiary Care ◽  
The Elderly ◽  
Tertiary Care Center ◽  
Factors Associated ◽  
One Year

ABSTRACT BACKGROUND: Hip fractures are one of the leading causes of disability and dependency among the elderly. The rate of hip fractures has been progressively increasing due to the continuing increase in average life expectancy. Surgical intervention is the mainstay of treatment, but with an increasing prevalence of comorbid conditions and decreased functional capacity in elderly patients, more patients are prone to postoperative complications. OBJECTIVES: Assess the value of surgical intervention for hip fractures among the elderly by quantifying the 1-year mortality rate and assessing factors associated with mortality. DESIGN: Medical record review. SETTING: Tertiary care center. PATIENTS AND METHODS: All patients 60 years of age or older who sustained a hip fracture between the period of 2008 to 2018 in a single tertiary healthcare center. Data was obtained from case files, using both electronic and paper files. MAIN OUTCOME MEASURES: The 1-year mortality rate for hip fracture, postoperative complications and factors associated with mortality. SAMPLE SIZE: 802 patients. RESULTS: The majority of patients underwent surgical intervention (93%). Intra- and postoperative complications were 3% and 16%, respectively. Four percent of the sample died within 30 days, and 11% died within one year. In a multivariate analysis, an increased risk of 1-year mortality was associated with neck of femur fractures and postoperative complications ( P =.034, <.001, respectively) CONCLUSION: The 1-year mortality risk in our study reinforces the importance of aggressive surgical intervention for hip fractures. LIMITATION: Single-centered study. CONFLICT OF INTEREST: None.

The Effect of Perforator Skeletonization on Pedicled Fasciocutaneous Flaps of the Lower Extremity: A Systematic Review

2020 ◽  
Vol 36 (09) ◽  
pp. 634-644
Author(s):  
Carol E. Soteropulos ◽  
Nikita O. Shulzhenko ◽  
Harry S. Nayar ◽  
Samuel O. Poore
Keyword(s):  
Systematic Review ◽  
Lower Extremity ◽  
Complication Rate ◽  
Perforator Flap ◽  
Free Tissue Transfer ◽  
Cochrane Central Register ◽  
Fasciocutaneous Flaps ◽  
Tissue Transfer ◽  
Individual Participant ◽  
The Impact

Abstract Background Lower extremity defects often require free tissue transfer due to a paucity of local donor sites. Locoregional perforator-based flaps offer durable, single-stage reconstruction while avoiding the pitfalls of microsurgery. Multiple harvest techniques are described, yet few studies provide outcome comparisons. Specifically, no study has examined the impact of perforator flap pedicle skeletonization on reconstructive outcomes. This systematic review characterizes technique and impact of pedicle skeletonization on perforator-based fasciocutaneous flaps of the lower extremity. Methods PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were reviewed for literature examining perforator-based fasciocutaneous flaps from knee to ankle, from January 2000 through November 2018. The Preferred Reporting Items for Systematic Reviews-Individual Participant Data (PRISMA-IPD) structure was used. Results Thirty-six articles were included for quantitative analysis. Of 586 flaps, 365 were skeletonized (60.1%) with 58 major (9.9%) and 19 minor complications (3.2%). With skeletonization, overall reoperative rate was higher (odds ratio [OR]: 9.71, p = 0.004), specifically in propeller (OR: 12.50, p = 0.004) and rotational flaps (OR: 18.87, p = 0.004). The complication rate of rotational flaps also increased (OR: 2.60, p = 0.04). Notably, skeletonization reduced complications in flaps rotated 90 degrees or more (OR: 0.21, p = 0.02). Reoperative rate of distal third defects (OR: 14.08, p = 0.02), flaps over 48 cm2 (OR: 33.33, p = 0.01), and length to width ratios over 1.75 (OR: 7.52, p = 0.03) was increased with skeletonization. Skeletonization increased complications in traumatic defects (OR: 2.87, p = 0.04) and reduced complications in malignant defects (OR: 0.10, p = 0.01). Conclusion Pedicled, perforator-based flaps can provide a reliable locoregional alternative to free tissue transfer for lower extremity defects. Though skeletonization increased the overall reoperative rate, the complication rate for flaps with 90 degrees or more of rotation was significantly reduced. This suggests skeletonization should be considered when large rotational movements are anticipated to reduce complications that can arise from pedicle compression and venous congestion.

Sign in / Sign up

Export Citation Format

Share Document