Copyright © 2015 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. Risk Assessment for Free Tissue Transfers: Is Old Age a Determining Factor? Bu ¨lent Sac ¸ak, MD,  Zeynep D. Akdeniz, MD, y Furkan Certel, MD,  Fatma Nihal Durmus ¸ Kocaaslan, MD,  Betu ¨l Tuncer, MD,  and Oz ¨han C ¸ elebiler, MD  Introduction: Free tissue transfers are more often performed in the elderly with the increase in geriatric patient population. The aim of this study was to investigate the effect of advanced age in recon- structive microsurgery procedures and analyze the association of other variables with complications and surgical success. Patients and Method: A retrospective review of 70 consecutive free tissue transfers between January 2012 and June 2013 was performed. Patients were divided into 2 groups: those younger than 60 years and those aged 60 years or older. Besides demographics, the American Society of Anesthesiologists (ASA) risk score, comorbid conditions, and anatomic locations for surgery (head and neck, extremities, trunk), operative time, need for reoperation, intensive care unit (ICU) admission and blood transfusion, length of hospital stay, medical and surgical complications, as well as partial and total flap loss were noted and analyzed. Results: A total of 71.4% of the patients were younger than 60 years (n ¼ 50; average, 37.4 y), and 28.6% of the patients were 60 years or older (n ¼ 20; average, 67.5 y). None of the other collected data showed significant difference between the groups. Although age was not associated with ICU admission, the location of the reconstruction site and the operative time were found to have a significant correlation with ICU referral. In this series, the operative time correlated with medical complications but not with surgical complications. Higher ASA scores did have a negative effect on the incidence of medical complications (P ¼ 0.028). Conclusions: This retrospective review demonstrates that age alone is not an independent variable for increased risk in microvascular reconstruction. However, operative time, ASA risk score, and location of the reconstruction site are more associated with the overall success of free tissue transfers. Key Words: flap, Geriatrics, reconstructive microsurgery (J Craniofac Surg 2015;26: 856–859) T he advances in medicine, among many other reasons, provided a steady and striking increase in life expectancy worldwide over the last decades. The burden of this increase for health providers is to manage an increasing number of patients with comorbidities and disabilities. In the perspective of reconstructive plastic surgery in particular, this increase implies an increase in the number of free tissue transfers for the elderly people, in parallel with the advances in microvascular tissue transfers. The success rate of free flap transfers is shown to be very high. 1 Technically demanding and long-lasting procedures for the elderly patients remain a challenge because this population frequently present with comorbid con- ditions such as obesity, cardiovascular and pulmonary diseases, as well as metabolic disorders, which can have detrimental effects perioperatively and postoperatively. 2 The objective of this study was to assess and compare the results of free tissue transfers in young and elderly patients to evaluate whether age may be defined as a key determining factor for successful free tissue transfers. PATIENTS AND METHODS Seventy consecutive patients who underwent free flap transfer in Marmara University Department of Plastic Surgery between Jan- uary 2012 and July 2013 were included in the study. The patients were divided into 2 groups: the first group was younger than 60 years, and the second group was 60 years or older. Demographic data and medical history were obtained. The locations of recon- struction sites, the causes of the defects, and flap selections accord- ing to location were noted. All patients were examined preoperatively by an anesthesiolo- gist, and their physical statuses were scored according to the American Society of Anesthesiologists (ASA) classification. 3 All procedures were performed by the first author of this study. Operative time, flap survival, postoperative medical (cardiac arrhythmia, atelectasia, hypotension, pneumonia, renal impairment, atrial fibrillation, pulmonary edema, venous thromboembolism, septic shock, death) and surgical (hematoma, seroma, wound infection, wound dehiscence, partial and total flap loss) compli- cations were recorded. The patients’ need for intensive care unit (ICU) admission, hospitalization time, and need for blood transfu- sions were also noted. In addition to the comparison of data for the 2 age groups, complications, operative time, hospitalization period, location of reconstruction, and ICU admissions were analyzed to further determine the predictive factors for successful free tissue transfers. Statistical analysis was performed using SPSS software version 10.0 (SPSS Inc, Chicago, IL). The groups were compared for complications, ICU referral, blood transfusions, and hospitalization time. Data were further analyzed to determine factors affecting ICU From the  Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University School of Medicine, Istanbul, and the y Department of Plastic Reconstructive and Aesthetic Surgery, Adana Numune Teach- ing and Research Hospital, Adana, Turkey. Received November 28, 2014. Accepted for publication January 30, 2015. Address correspondence and reprint requests to Zeynep D. Akdeniz, MD, Department of Plastic Reconstructive and Aesthetic Surgery, Marmara University School of Medicine, Fevzi Cakmak Mah 41, Ust Kaynarca- Pendik, Istanbul, Turkey; E-mail: zeynepakdeniz@gmail.com Presented at the 12th Congress of the European Federation of Societies for Microsurgery, April 3-5, 2014, Barcelona, Spain. This work should be attributed to the Marmara University School of Medicine. The authors report no conflicts of interest. Copyright # 2015 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001667 CLINICAL STUDY 856 The Journal of Craniofacial Surgery  Volume 26, Number 3, May 2015