Flap-Based Lower Extremity Reconstruction in the Elderly-Is It Safe and Does Age Impact Ambulation?

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Geriatric Medicine

Background:

• Lower extremity (LE) reconstruction in the elderly presents challenges due to age-related conditions like osteoarthritis, osteoporosis, and peripheral artery disease (PAD).
• These conditions can compromise limb integrity and function, necessitating careful consideration in surgical planning and postoperative care.
• Assessing outcomes in this demographic is crucial for optimizing treatment strategies.

Purpose of the Study:

• To evaluate postoperative complications and functional recovery after lower extremity reconstruction in elderly patients (≥60 years).
• To compare outcomes between elderly patients and a younger control group (<60 years).

Main Methods:

• Retrospective review of patients (≥18 years) who underwent post-traumatic LE reconstruction with flap surgery between 2007 and 2022.
• Comparison of demographics, flap/wound characteristics, complications, and ambulation status between elderly (≥60 years) and control (<60 years) cohorts.
• Logistic regression analysis to determine factors associated with final ambulation status.

Main Results:

• Elderly patients had a higher rate of amputation post-flap surgery (p=0.002).
• Postoperatively, 22.4% of elderly patients achieved independent ambulation versus 49.5% in the control group.
• Wheelchair dependence was significantly higher in the elderly cohort (46.9%) compared to the control group (22.7%) (p<0.001).
• Older age was independently associated with worse final ambulation status (p=0.033).

Conclusions:

• Lower extremity reconstruction can be safely performed in patients aged 60 years and older.
• Older age is an independent predictor of poorer postoperative ambulation outcomes.
• Preoperative assessment of gait and strength, coupled with early postoperative rehabilitation, may enhance functional recovery in elderly LE reconstruction patients.