Reliability of distally based sural flap in elderly patients: comparison between elderly and young patients in a single center

Efficacy of breast reconstruction in elderly women (>60 years) using deep inferior epigastric perforator flaps: A comparative study

BACKGROUND

The indications for microsurgical breast reconstruction remain debated, particularly concerning the safety of deep inferior epigastric perforator (DIEP) flaps in elderly women. Free tissue transfer still carries a risk of perioperative morbidity and mortality in elderly patients. We conducted this comparative study to clarify this issue.

METHODS

This retrospective cohort study included all unilateral DIEP breast reconstructions performed at a single institution. Patients were divided into two groups based on age: an elderly (60 years or older) and a non-elderly cohort (younger than 60 years). Demographic and comorbidity data were secondary predictor variables. The primary outcomes were complete flap loss, partial flap loss, and the need for flap re-exploration. The secondary outcomes included surgical site occurrences, such as wound healing-related complications, seroma, and others.

RESULTS

We included 214 flaps, 177 in the non-elderly and 37 in the elderly cohort. Elderly women had slightly higher comorbidity rates than those of non-elderly women, although these differences were not statistically significant. BMI was significantly lower in elderly women than in non-elderly women. The incidence of total or partial flap loss did not differ significantly between the two cohorts (2.7% vs 1.1%, p = 0.459% and 0.0% vs 5.1%, p = 0.161), nor did the flap re-exploration (8.1% vs 10.1%, p = 0.937). Similarly, postoperative complication rates did not differ significantly between the two groups (45.9% vs 61.8%, p = 0.074). On logistic regression, being elderly was not a risk factor for complete flap loss, nor for any complications. The overall success rate for the non-elderly cohort was 98.7%, whereas that for the elderly cohort was 97.3%.

CONCLUSIONS

Microsurgical breast reconstruction using DIEP is safe in elderly patients, as it achieves outcomes and complications rates comparable to those observed in a younger population. Patients should not be denied DIEP flaps because of their age alone.

Comparison of "complications" and functional outcome of anterolateral thigh flap and sural neurofasciocutaneus flap for foot and ankle reconstruction: A single center cohort study

BACKGROUND

Skin and soft-tissue defects around the foot and ankle remain a challenge for orthopedic and plastic surgeons. Anterolateral thigh (ALT) flap and sural neurofasciocutaneous (NFC) flap are both used to reconstruct lower-extremity soft-tissue defects. The purpose of this study was to compare outcomes of the two flaps and attempt to provide an optimal strategy.

METHODS

A retrospective study was conducted, reviewing data from 93 patients who underwent reconstruction of wounds around the foot and ankle with ALT flap (42 cases) or NFC flap (51 cases) from January 2014 to January 2020. Patients' demographics, characteristics of the defect, complications, cosmetic appearance, and functional outcome were analyzed, and statistical analysis was performed.

RESULT

There was no difference in gender and etiology; however, NFC flaps were more frequently used in elderly patients. Mean size of the flap in the ALT group was significantly larger in comparison with the NFC group. The ALT group had longer operation and hospitalization time than the NFC group (P < 0.05). The incidence of partial necrosis in ALT group was significantly lower than that in NFC group, while its general complications rate was higher. In long-term follow-up, esthetic appearance of the reconstructed site was comparable in both groups, the ALT group had a higher ratio of revision surgery. Moreover, the ALT group showed better overall esthetic outcomes in the donor site.

CONCLUSIONS

The study showed that anterolateral thigh flaps in wound coverage of foot and ankle achieved better outcomes than neurofasciocutaneous flaps in terms of recipient benefits and donor-site compromise with a special indication for larger and more distally located defects.