Summary
Introduction
Impaired microcirculation, along with an increase in chronic medical conditions in
the geriatric cohort, may favor the development of soft-tissue defects in the lower
extremity and equally impair the options for plastic-reconstructive surgery. In particular,
outcome analyses in the increasing patient cohort ≥ 80 years (octogenarians) are limited.
Methods
Setting 80 years as the cutoff, we conducted an age-related outcome analysis of all
patients undergoing free-flap reconstruction of the lower extremity from 2014 to 2020,
comprising the American Society of Anesthesiologists (ASA) score and Charlson Comorbidity
Index (CCI) as the possible outcome predicting factors.
Results
During the study period, a total of 424 free flaps were performed in 385 patients
(∅: 54.7 years ± 16.1; range: 9–89), including 19 octogenarians. Compared with the
younger patient cohort, there was a significantly higher rate of early flap revision
(p = 0.023) and flap loss (p = 0.028). Furthermore, the mean length of hospital (60.6 ± 37.6 vs. 51.1 ± 37.0)
and intensive care unit/intermediate care stay (6.5 ± 15.0 vs. 3.5 ± 8.5) was extended
(n.s.). The ASA score presented an independent predictor for major surgical [odds
ratio (OR): 1.66; p = 0.041) and medical complications (OR: 3.97; p<0.001). Neither the CCI nor the ASA served as an independent predictor for total
flap loss.
Conclusion
Free-flap reconstruction of the lower extremity in octogenarians is associated with
a higher risk of flap revision and flap loss. Considering the prolonged immobilization
associated with increased morbidity following limb amputation, it presents still a
reasonable option to achieve limb salvage in carefully chosen patients. An adequate
tool to predict the success of free-flap survival is still unavailable.
Keywords
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Article info
Publication history
Published online: October 17, 2022
Accepted:
October 11,
2022
Received:
January 7,
2022
Identification
Copyright
© 2022 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
