Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California, USA.
Microsurgery. 2024 Oct;44(7):e31239. doi: 10.1002/micr.31239.
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.
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.
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).
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.
下肢（LE）重建在老年人群中是一个多方面的挑战，主要是由于与年龄相关的退行性变化、合并症和功能下降。老年人经常会出现骨关节炎、骨质疏松症以及心血管和外周动脉疾病（PAD）等疾病，这会严重损害下肢的结构完整性和功能。因此，我们旨在评估老年患者下肢重建后的术后并发症和功能恢复情况。
本研究纳入了 2007 年至 2022 年间在一家一级创伤中心接受创伤后下肢重建伴皮瓣重建的年龄≥18 岁的患者。记录患者的人口统计学资料、皮瓣/伤口特征、并发症以及老年（≥60 岁）和对照组（<60 岁）患者的活动能力。主要结局是通过逻辑回归模型评估最终的活动能力。次要结局包括术后并发症。
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）。两组患者术前的活动能力无显著差异（p=0.053）。术后，有 22.4%的老年患者最终能够独立行走，而<60 岁的患者为 49.5%。在老年组中，14.3%的患者可以使用辅助设备（拐杖、助行器等）行走，而对照组为 26.5%。46.9%的老年患者需要轮椅，明显高于<60 岁的患者（22.7%）（p<0.001）。多变量回归证实，年龄较大与最终非活动状态相关（p=0.033）。
60 岁或以上的患者行下肢重建是安全的，但年龄较大与术后行走能力显著下降独立相关。术前评估，包括步态和肌肉力量，以及术后早期开始康复，可能会提高老年患者下肢重建后的行走能力。
