Free-flap reconstruction of the lower limb in octogenarians – A comparative analysis of indications, management, and outcomes. (January 2023)

• Record Type: Journal Article
• Authors: von Glinski, Maxi; Wallner, Christoph; Wagner, Johannes Maximilian; Dadras, Mehran; Sogorski, Alexander; Drysch, Marius; Reinkemeier, Felix; Voigt, Maria; Lehnhardt, Marcus; Behr, Björn
• Is Part Of: Journal of plastic, reconstructive & aesthetic surgery. Volume 76(2023)
• Page Start: 230
• Page End: 237
• Publication Date: 2023-01
• Subjects: Microsurgery -- Free flaps -- Lower limb -- Octogenarians -- ASA -- Charlson comorbidity index; Surgery, Plastic -- Great Britain -- Periodicals; Reconstructive Surgical Procedures -- Periodicals; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.bjps.2022.10.020
• Languages: English
• ISSNs: 1748-6815

Abstract

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.