Free Flap Reconstruction of the Extremities in Patients Who are ≥65 Years Old: A Single-Center Retrospective 1-to-1 Matched Analysis

Spindler, Nick; Pieroh, Philipp; Spiegl, Ulrich; Arakelyan, Sergey; Fakler, Johannes K. M.; Heyde, Christoph-Eckhard; Langer, Stefan

doi:10.2147/cia.s300558

Cited by 6 publications

(7 citation statements)

References 37 publications

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“…The median hospital stay of 28 days in our study appears relatively long but is similar to previous published data on microsurgical extremity reconstructions. 48,49 Higher age was related to longer hospitalization time, which demonstrates that (major) complications, besides their possible effect on the final outcome, also have a markedly impact on hospitalization time with all its consequences such as prolonged immobilization, delayed rehabilitation and higher costs.…”

Section: Discussionmentioning

confidence: 98%

Outcomes and Risk Factors in Microsurgical Forefoot Reconstruction

Mayr-Riedler

Wacker

Gedrich

et al. 2022

J Reconstr Microsurg

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Background: Defects at the forefoot frequently require microsurgical reconstruction, however reconstructive failure can lead to results inferior to primary amputation. The purpose of this study was to identify independent factors affecting surgical outcomes and hospitalization time in these patients. Methods: All patients that underwent free flap reconstruction of the forefoot between 2008 and 2019 were reviewed retrospectively. Statistical evaluation included binary logistic regression and correlation analysis. Results: A total of 93 free flap procedures were performed in 87 patients. The most common defect etiologies were acute trauma (30 cases; 32.3%), diabetic foot syndrome (20 cases; 21.5%) and infection (17 cases; 18.3%). Muscle flaps were used in 50 cases (53.8%) and fasciocutaneous flaps were used in 43 cases (46.2%). Major complications occurred in 24 cases (25.8%) including 11 total flap losses and 2 partial flap losses. Minor complications occurred in 38 cases (40.9%). Patients aged 60 years or above were at significant higher risk for major complications (p=0,029). Use of fasciocutaneous flaps (OR: 14.341; p=0.005), arterial hypertension (OR: 18.801; p=0.014) and operative time (min) (OR: 1.010; p=0.029) were identified as individual risk factors for major complications. Two venous anastomoses significantly reduced the risk for major complications (OR: 0.078; p=0.022). Multi resistant bacterial wound colonization (OR: 65.152; p<0.001) and defect size (OR: 1.007; p=0.045) were identified as independent risk factors for minor complications. The median hospital stay was 28 days (7-85 days). Age significantly correlated with the length of hospital stay (r=0.405, p<0.01). Conclusion: Our study identified independent risk factors that might help to make individual decisions whether to target microsurgical forefoot reconstruction or primary amputation. Two venous anastomoses should be performed whenever feasible, and muscle free flaps should be preferred in patients at higher risk for major surgical complications.

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Section: Discussionmentioning

confidence: 98%

Outcomes and Risk Factors in Microsurgical Forefoot Reconstruction

Mayr-Riedler

Wacker

Gedrich

et al. 2022

J Reconstr Microsurg

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“…A cobertura com retalhos é reportada como sendo mais comum em pacientes do sexo masculino, também em concordância com nosso estudo, provavelmente relacionado com o fato da principal causa de falha de cobertura ser o trauma 2,4,5 .…”

Section: Discussionunclassified

“…Em relação ao tempo de internação, a média foi de 19.8 dias, variando de 0 a 88. 2 Já ao tempo cirúrgico, a literatura traz uma média de 4.5h, variando de 2.87 a 8.06h 2,5 . Estes valores também estão próximos aos encontrados em nosso estudo, tendo em vista que a diferença estatística observada no tempo de internação para retalhos de rotação comparados aos retalhos livres deve-se ao fato da complexidade das falhas de cobertura, bem como na complexidade do procedimento realizado.…”

Section: Discussionunclassified

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Experiência de um Hospital Terciário com Falhas de Cobertura e seu Tratamento com Retalhos Livres e Rotacionais

et al. 2023

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Introdução: A cobertura de falhas cutâneas com retalhos livres e rotacionais é uma proposta estabelecida de tratamento, principalmente com o aumento da capacidade técnica e de instrumentais. Existe uma grande variedade de retalhos descritos, e apesar do esforço para reduzir os erros de técnica, as taxas de complicações ainda são altas. Estas complicações dependem de fatores inerentes ao paciente, à cirurgia e ao manejo pós-operatório. Este estudo propõe elucidar a população submetida a tratamento de falha de cobertura com retalhos livres, rotacionais e de avanço, tal como a taxa de complicação e necessidade de reabordagem. Métodos: Estudo retrospectivo baseado em dados de prontuário de pacientes submetidos a tratamento cirúrgico de falha de cobertura com retalhos livres e rotacionais no período de janeiro de 2015 a dezembro de 2021 em um hospital terciário. Resultados: A taxa de reoperação global foi de 68,8%, sendo 85,7% nos retalhos livres e 57,8% nos retalhos de rotação (p<0,001), com diferença estatística para tempo de internação (p=0,001) e tempo cirúrgico (p<0,001), sem diferença para tamanho da falha (p=0,458). A taxa de falha global dos retalhos foi de 16,9%, sendo 23,8% nos retalhos livres e 12,5% nos retalhos de rotação (p=0,032). A falha do retalho apresentou diferença estatística para o tamanho da falha (p=0,004), tempo cirúrgico (p=0,040) e tempo de internação em dias (p=0,015). Conclusão: a taxa de falha dos retalhos e de reoperação são consistentes com os dados da literatura. As comorbidades podem ser controladas por equipes multidisciplinares de forma a não influenciarem no resultado pós-operatório.

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“…In fact, higher body weight has been protective in some cases [9]. Many authors have been unable to nd an association between advanced age and harmful outcomes [10][11][12][13][14]. Further research is needed to delineate associations between free ap reconstructive surgery and any subsequent complications.…”

Section: Introductionmentioning

confidence: 99%

Adverse Outcomes Following Free Tissue Transfer: A 3-year Experience From a Major Referral Centre

Nann

Yip

Glanville

et al. 2021

Preprint

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BackgroundFree tissue transfer encompasses a variety of techniques by which tissue is moved to another region of the body, with anastomosis of the divided artery and vein. Currently, success rates are reported at 91-99% [1], however, little is known regarding predictors for adverse outcomes.We aim at identifying predictors for negative outcomes following free flap surgery; and predict that elderly patients and patients with head and neck free flaps will have inferior outcomes due to comorbidity.MethodsThis is a retrospective case series. All free flap surgeries between 02/2018 to 02/2021 were identified using the electronic operation record system at Flinders Medical Centre. Chi squared hypothesis testing assessed patient factors and implications on outcome. Results67 patients of varying demographics were included in this study. The odds of wound infection was much higher in patients aged older than 65 (OR: 4.1 (95%CI 1.24-13.6, z-score: 2.31, p=0.017)). The odds of unplanned reoperation was also higher in this population (OR: 13.7 (95%CI 1.42-132.9, p=0.0053)). Free flap location was significant in determining whether patients would require a subsequent blood transfusion (p=0.0071). Head and neck patients did not experience a higher rate of adverse events.ConclusionPatients aged 65 and older are more likely to require treatment for infection and more often require reoperation because of flap related issues. Patients with limb free flaps are more likely to require transfusions. Head and neck patients did not have higher complication rates.

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Free Flap Reconstruction of the Extremities in Patients Who are ≥65 Years Old: A Single-Center Retrospective 1-to-1 Matched Analysis

Cited by 6 publications

References 37 publications

Outcomes and Risk Factors in Microsurgical Forefoot Reconstruction

Outcomes and Risk Factors in Microsurgical Forefoot Reconstruction

Experiência de um Hospital Terciário com Falhas de Cobertura e seu Tratamento com Retalhos Livres e Rotacionais

Adverse Outcomes Following Free Tissue Transfer: A 3-year Experience From a Major Referral Centre

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