title: Microsurgical reconstruction for post-traumatic defects of lower leg in the elderly: A comparative study.
abstract: BACKGROUND
  Lower leg microsurgical reconstruction in the elderly is challenging, especially for post - traumatic defects. The present study aimed to evaluate the risk factors, management and outcome of free tissue transfer in patients older than 65 years of post-traumatic defects.
  
  
  METHODS
  Retrospective chart review was performed for all patients older than 18 years undergoing free tissue transfer for post-traumatic lower leg reconstruction from April 2000 to November 2014. A comparative study was designed to identify risk factors and outcome.
  
  
  RESULTS
  In total, 197 patients (ages 18-64) and 44 patients (ages ≥65, average 71.7±6.3) were included and allocated into cohort 1 and 2, respectively. Cohort 2 had a higher rate of diabetes mellitus and/or peripheral artery disease (46.6%, P<0.01). There was no significant difference in major flap complications, donor site complications and amputation rates (P>0.05). A higher rate of intensive care unit (ICU) admission was observed in cohort 2 (37.8%, P<0.01). Comparable limb salvage rates were recorded (97.1% and 95.6%, P=0.59) with an average follow-up of 25.9±30.1months in cohort 1 and 23.7±16.6months in cohort 2.
  
  
  CONCLUSIONS
  Post-traumatic microsurgical free tissue transfer to the lower leg can be performed safely in patients older than 65 years with high success rate and manageable complications.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Aesthetic Surgery Center, Union Hospital, Huazhong University of Science and Technology, 430022 Wuhan, PR China; Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany.
authors.forename: Lingyun
authors.initials: L
authors.lastname: Xiong
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany.
authors.forename: Emre
authors.initials: E
authors.lastname: Gazyakan
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Wähmann
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany.
authors.forename: Amir
authors.initials: A
authors.lastname: Bigdeli
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kremer
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany.
authors.forename: Leila
authors.initials: L
authors.lastname: Harhaus
authors.affiliation: Department of Plastic and Reconstructive Surgery, Aesthetic Surgery Center, Union Hospital, Huazhong University of Science and Technology, 430022 Wuhan, PR China.
authors.forename: Jiaming
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kneser
authors.affiliation: Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, 67071 Ludwigshafen, Germany. Electronic address: christoph.hirche@bgu-ludwigshafen.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hirche
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D023821:Limb Salvage / Q000379:methods; D035002:Lower Extremity / Q000293:injuries / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Lower leg; Microsurgery; Old patients