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

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 +/- 30.1 months in cohort 1 and 23.7 +/- 16.6 months in cohort 2. Conclusion: 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. (C) 2016 Elsevier Ltd. All rights reserved.