Subject(s)
Costal Cartilage/transplantation , Nasal Cartilages/surgery , Rhinoplasty/methods , Asian People , Esthetics , Humans , SingaporeABSTRACT
Free flap tissue transfer has become the gold standard for reconstruction of composite head and neck defects. We sought to investigate the efficacy and morbidity of these procedures in the elderly. We retrospectively reviewed 245 head and neck free flap procedures (234 patients). Patients were stratified by age group (≥ or <65 years). Univariate and multivariate analyses were used to evaluate the following primary outcomes - free flap survival, postoperative medical and surgical complications and 30-day mortality. We found that free flap success and surgical complication rates were similar between the two age groups. Overall flap success and perioperative mortality rates were 94.3% and 2.1% respectively. Medical complications were significantly more common in the elderly group (p <0.001) and this correlated with comorbidity (OR = 2.81, p = 0.044) and advanced tumour stage (OR = 10.20, p= 0.029). Age was not independently associated with poor outcomes in our cohort. We then performed a systematic review of similar case-control studies worldwide and compared their findings with our results. We conclude that advanced age does not preclude free flap success in head and neck reconstruction. Rather, the presence of comorbidity appears to predict the development of medical complications postoperatively. Elderly patients with low comorbidity scores may be offered free flap reconstruction with less reservation.
Subject(s)
Free Tissue Flaps , Head and Neck Neoplasms/surgery , Plastic Surgery Procedures/methods , Aged , Aged, 80 and over , Female , Head and Neck Neoplasms/mortality , Humans , Male , Middle Aged , Postoperative Complications/mortality , Predictive Value of Tests , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
A right hand dominant young ethnic Indian male developed heterotopic ossification (HO) of his right index finger after a contusion due to a fall. There were no open wounds clinically and no fractures noted on plain radiographs. Stiffness of the proximal interphalangeal joint and generalised swelling of the digit was present about three weeks after the injury. Radiographic investigations of the digit demonstrated soft tissue ossification volar to the proximal and middle phalanges. Non-operative management was instituted. This case report demonstrates that heterotopic ossification of digits can occur from closed, blunt trauma in the absence of bony injuries. Current literature on management of digital heterotopic ossification is minimal due to low incidence.
