Microsurgical reconstruction for post—traumatic defects of lower leg in the elderly: A comparative study

Xiong, Lingyun; Gazyakan, Emre; Wähmann, Matthias; Bigdeli, Amir K.; Kremer, Thomas; Harhaus, Leila; Sun, Jiaming; Hirche, Christoph

doi:10.1016/j.injury.2016.09.010

Cited by 23 publications

(23 citation statements)

References 22 publications

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“…In contrast, this was likewise observed and discussed by other studies on microvascular reconstruction in the elderly patients. 11,12,14,44 Collected data also showed no statistical difference in medical complications between elderly and very old patients in contrary to a recent database analysis, which showed that medical complications and mortality are more common in patients with age older than 80 years. 45 The review of the total flap loss showed no significant difference between the two age cohorts (6.3 and 5.1%, respectively) as both are comparable to the literature.…”

Section: Discussioncontrasting

confidence: 78%

“…However, most of studies about microsurgical reconstruction focus on patients older than 65 years without stratification on age. 14,17 Therefore, the aim of our study was to evaluate the safety and reliability of microvascular flap transfers in the elderly patients with special focus on geriatric patients with a high cutoff of ! 80 years.…”

Section: Discussionmentioning

confidence: 99%

“…The anatomy is predictable with a long, safe pedicle, it may be performed in supine position, and it is reliable in cases of atherosclerosis. 14,35 Tukiainen et al showed that the rectus abdominis muscle among the LD muscle is recommendable in cases of major tissue defect and critical limb ischemia even in combination with vascular reconstruction. 9 Daigeler et al demonstrated that the (pedicled) vertical rectus abdominis myocutaneous/transverse rectus abdominis myocutaneous flap is a valuable treatment option in soft tissue reconstruction of oncologic patients.…”

Section: Discussionmentioning

confidence: 99%

“…13 Most previous studies set the cutoff between 65 and 70 years. 7,14,15 However, the demographic change with an increasingly old population leads to the necessity of evaluating complex microvascular reconstructions in not only elderly but very old patients. So far, only a few analyses have been conducted concerning the perioperative risk assessment of patients older than 80 years.…”

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confidence: 99%

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Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases

Wähmann

Henn

et al. 2019

J reconstr Microsurg

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Background In elderly patients, complex soft tissue defects are increasingly observed due to the prolonged life expectancy and accompanying comorbidities. The aim of this study is to evaluate whether free tissue transfer is safe in very old patients without additional risk and complications. Methods All patients older than 65 years undergoing free tissue transfer between November 2007 and September 2016 were reviewed in a retrospective study. Two cohorts were compared regarding perioperative morbidity and postoperative outcome (cohort 1 [old patients, ages 65–79]; cohort 2 [very old patients, ages ≥ 80]). Results In total, 256 patients were included in the study (cohort 1 [n = 217]; cohort 2 [n = 39]). Overall, 262 free flaps were performed due to a second microsurgical reconstruction in six cases. No statistically significant differences between cohorts were observed regarding surgical complications, total flap losses, and mortality. Detailed evaluation of cohort 2 revealed a significant learning curve during the observation period regarding the perioperative management and procedure of soft tissue reconstruction: operation length as well as postoperative intensive care unit stay decreased significantly over time (p < 0.05) and also surgical complications showed a positive trend (p = 0.07). We ascertained a shift toward a “more reliable” flap selection from predominantly anterolateral thigh flap) to axial flaps such as rectus abdominis and latissimus dorsi flaps. Conclusion Our study showed that age is not associated with an increased risk of postoperative complications. Reliable muscle free flaps, two-stage procedures, and safe vascular supply are important strategic aspects to achieve microvascular tissue transfer with high success rates in geriatric patients.

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Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases

Wähmann

Henn

et al. 2019

J reconstr Microsurg

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As a result of technical advancements and increasing microsurgical experience, free flap surgery has evolved to a routine procedure for reconstruction of complex surgical defects that can be safely employed with success rate up to 99%. [1][2][3][4][5][6][7][8][9][10][11] However, re-exploration rates up to 15% are evident in the literature, 9,12 primarily depending on the location, the underlying cause, and the type of defects. Here, free flap complication rates continue to be higher in lower extremity reconstruction

AbstractBackground Vascular occlusion after free flap surgery has become a rare complication but still poses a major challenge.

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confidence: 99%

Long-Term Outcome after Successful Lower Extremity Free Flap Salvage

Bigdeli

Gazyakan

Bauer

et al. 2018

J reconstr Microsurg

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Background Vascular occlusion after free flap surgery has become a rare complication but still poses a major challenge. It necessitates urgent re-exploration, but the logistic challenge to provide sufficient resources for the emergency intervention remains. The aim of this study was to analyze the long-term outcome after successful lower extremity free flap salvage. Methods A single-center retrospective study including long-term follow-up was approved by the local ethics committee. From January 1999 to December 2010, a total of 581 free flaps were performed for lower extremity reconstruction. Eighty-six flaps required emergency re-exploration, of which 65 could be salvaged. Fifteen salvaged flaps were excluded from the study because of secondary amputation. Of 50 patients, 29 (6 females and 23 males) were eligible for follow-up. The mean follow-up time was 54.5 ± 32.9 months. Health-related quality of life (Short Form 36 [SF-36]) and scar quality (Vancouver Scar Scale [VSS]) were analyzed. Results The overall flap survival rate was 94.7% and the total loss rate was 5.3%. The re-exploration rate was 14.8% (86 of 581 flaps). The salvage rate was 75.6% (65 of 86 flaps). Twenty-one free flaps were totally lost (24.4%). Partial flap loss occurred in 12 cases (14.0%); 67.5% of the vascular complications occurred during the first 24 hours, 20.9% between 24 and 72 hours, and 11.6% after more than 72 hours. The mean time from the first signs of impaired flap perfusion to re-exploration was 1.3 ± 0.4 hours, and from free tissue transfer to re-exploration was 16.2 ± 1.9 hours. The overall scar appearance was good with an average VSS score of 4.0 points. The average SF-36 physical component score was 54.4 ± 5.4 and the mental component score was 63.1 ± 10.7. Conclusion Careful monitoring and the opportunity for urgent re-exploration are the key to success for free flaps salvage. Following these principles, an acceptable long-term outcome can be achieved.

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Clinical utility of the modified frailty index in predicting adverse outcomes in patients undergoing lower extremity free flap reconstruction

Deldar,

Huffman,

Bovill

et al. 2023

Microsurgery

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BackgroundIdentifying at‐risk patients for complications remains challenging in patients with chronic lower extremity (LE) wounds receiving free tissue transfer (FTT) for limb salvage. The modified‐5 frailty index (mFI‐5) has been utilized to predict postoperative complications, yet it has not been studied in this population. The aim of this study was to determine the utility of the mFI‐5 in predicting adverse postoperative outcomes.MethodsPatients ≥60 years, who underwent LE FTT reconstruction at a single institution from 2011 to 2022, were retrospectively reviewed. Patient characteristics, mFI‐5, and postoperative outcomes were collected. Cohorts were divided by an mFI‐5 score of <2 or ≥2.ResultsA total of 115 patients were identified, of which 71.3% (n = 82) were male, 64.3% (n = 74) had a mFI‐5 score of ≥2, and 35.7% (n = 41) had a score <2. The average age and body mass index were 67.8 years and 28.7 kg/m2, respectively. The higher mFI‐5 cohort had lower baseline albumin levels (3.0 vs. 4.0 g/dL, p = .015) and higher hemoglobin A1c levels (7.4 vs. 5.8%, p < .001). The postoperative length of stay was longer in the higher mFI‐5 cohort (18 vs. 13.4 days, p = .003). The overall flap success was 96.5% (n = 111), with no difference between cohorts (p = .129). Postoperative complications were comparable between cohorts (p = .294). At a mean follow‐up of 19.8 months, eight patients (7.0%) underwent amputation, and 91.3% (n = 105) were ambulatory.ConclusionHigh microsurgical success rates can be achieved in comorbid patients with high frailty indexes who undergo FTT for limb salvage. A multidisciplinary team approach may effectively mitigate negative outcomes in elderly, frail patients.

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Microsurgical reconstruction for post—traumatic defects of lower leg in the elderly: A comparative study

Cited by 23 publications

References 22 publications

Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases

Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases

Long-Term Outcome after Successful Lower Extremity Free Flap Salvage

Clinical utility of the modified frailty index in predicting adverse outcomes in patients undergoing lower extremity free flap reconstruction

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