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

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2024-09-20 DOI:10.1002/micr.31239

Artur Manasyan, Eloise W. Stanton, Erin Wolfe, Joseph N. Carey, David A. Daar

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引用次数: 0

Abstract

Introduction

Lower extremity (LE) reconstruction in the elderly population presents a multifaceted challenge, primarily due to age-related degenerative changes, comorbidities, and functional decline. Elderly individuals often encounter conditions such as osteoarthritis, osteoporosis, and cardiovascular and peripheral artery disease (PAD), which can severely compromise the structural integrity and function of the lower limbs. As such, we aim to assess postoperative complications and functional recovery following LE reconstruction in elderly patients.

Methods

Patients ≥ 18 years who underwent post-traumatic LE reconstruction with flap reconstruction at a Level 1 trauma center between 2007 and 2022 were included. Patient demographics, flap/wound characteristics, complications, and ambulation for the elderly (≥ 60 years old) and the control (< 60 years old) cohorts were recorded. The primary outcome was final ambulation status, modeled with logistic regression. Secondary outcomes included postoperative complications.

Results

The mean ages of the control (n = 374) and elderly (n = 49) groups were 37.4 ± 12.6 and 65.8 ± 5.1 years, respectively. Elderly patients more frequently required amputation after flap surgery (p = 0.002). There was no significant difference between the two cohorts in preoperative ambulation status (p = 0.053). Postoperatively, 22.4% of elderly patients were independently ambulatory at final follow-up, compared to 49.5% of patients < 60. Of the elderly, 14.3% could ambulate with an assistance device (cane, walker, etc.), compared to 26.5% in the control group. A wheelchair was required for 46.9% of elderly patients, significantly higher than the 22.7% of those < 60 years of age (p < 0.001). Multivariate regression confirmed an association between older age and nonambulatory final status (p = 0.033).

Conclusion

LE reconstruction can likely be performed safely in patients 60 years of age or older. However, older age is independently associated with significantly worse postoperative ambulation. Preoperative assessment, including gait and muscle strength, and early initiation of postoperative rehabilitation can potentially improve ambulation in elderly individuals undergoing LE reconstruction.

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基于皮瓣的老年人下肢重建术--是否安全，年龄是否会影响行走？

引言老年人群的下肢（LE）重建面临着多方面的挑战，主要原因是与年龄相关的退行性变化、合并症和功能衰退。老年人经常会遇到骨关节炎、骨质疏松症、心血管疾病和外周动脉疾病（PAD）等疾病，这些疾病会严重损害下肢结构的完整性和功能。因此，我们旨在评估老年患者 LE 重建后的术后并发症和功能恢复情况。方法纳入2007年至2022年期间在一级创伤中心接受创伤后皮瓣重建术的年龄≥18岁的左下肢重建患者。记录老年组（≥ 60 岁）和对照组（60 岁）患者的人口统计学特征、皮瓣/伤口特征、并发症和行走情况。主要结果是最终的行走状况，采用逻辑回归建模。次要结果包括术后并发症。结果对照组（n = 374）和老年组（n = 49）的平均年龄分别为 37.4 ± 12.6 岁和 65.8 ± 5.1 岁。老年患者在皮瓣手术后更常需要截肢（P = 0.002）。两组患者的术前行走状况无明显差异（p = 0.053）。术后，22.4%的老年患者在最终随访时可以独立行走，而 60 岁患者的这一比例为 49.5%。在老年患者中，14.3% 的患者可以借助辅助设备（手杖、助行器等）行走，而对照组的这一比例为 26.5%。46.9%的老年患者需要使用轮椅，明显高于22.7%的60岁患者（p< 0.001）。多变量回归证实了老年与最终不行动状态之间的关联（p = 0.033）。结论 60 岁或以上的患者可以安全地进行 LE 重建。但是，年龄越大，术后行走能力越差。包括步态和肌肉力量在内的术前评估以及术后康复的早期启动有可能改善接受左侧肢体重建术的老年人的行走能力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.