Blood Count Parameters can be Useful in Predicting Vascular Events in Microvascular Surgery: Results of a Preliminary Study.

BACKGROUND: Vascular events are a major cause of flap failure and identifying patients who are at risk is of paramount importance. In the past, many studies have been conducted to investigate the effect of blood count parameters for ischemic events such as peripheral vascular diseases. AIMS: This study aimed to evaluate whether blood count parameters can have predictive value for vascular events in microvascular flap surgery. METHODS: Elective cases with free flap microsurgery performed in a single center were reviewed from 2015 to 2019. Demographic data, comorbidities, flap types, perioperative complications, and preoperative blood count parameters from the hospital records were screened. RESULTS: A total of 147 patients were included in the study, taken from the 163 patients undergoing free tissue transfer. The rate of thrombosis and partial necrosis was 8.8%, was 8.2%, respectively, and the total flap loss due to these complications was 5.4%. Only patient age, gender, and length of hospital stay were correlated with flap loss. According to the preoperative blood count results, there were significant differences between vascular events and leucocyte, and neutrophil counts. CONCLUSION: The findings of this preliminary study suggest that these parameters may be used in predicting vascular events in flap surgery.

Analysis of outcome for elderly patients after microvascular flap surgery: a monocentric retrospective cohort study.

OBJECTIVES: Increasingly, aging societies pose a challenge, particularly in the most developed countries. This trend leads to an increasing group of old and very old patients presenting unique requirements and challenges. One of these challenges consists in reassessment and adaption of established treatment strategies for the elderly patients. There is an ongoing discussion taking place among cranio-maxillo-facial surgeons about the appropriate extent of reconstructive flap surgery for old patients. MATERIALS AND METHODS: This monocentric retrospective cohort study investigated 281 reconstructions with microvascular flaps by comparing the risk for a negative outcome, which was defined as revision, flap loss, and patient death, between three subgroups of elderly patients and younger patients. The three subgroups of elderly patients were defined as-1: young old (65-74 years), 2: old (75-84 years), and 3: oldest old (≥ 85 years). The group of the younger patients was defined by age between 50 and 64 years. Data were obtained within a defined period of 42 months. RESULTS: Significant correlations with a negative outcome were found for the variables stay on IMC/ICU, multiple flaps, and radiotherapy prior surgery. Our data showed no significant correlation between age and a higher risk for a negative outcome. CONCLUSION: Defect reconstruction with microvascular flaps in old patients is not related with a higher risk for a negative outcome. CLINICAL RELEVANCE: Independently of age, treatment with microvascular flaps is an option for all operable patients, with an indication for oncologic surgery. For optimal therapy planning, individual patient resources and preferences should be considered instead of chronologic age.