Navigating the 'Silver Tsunami' in Limb Salvage: Lower Extremity Free Flap Outcomes in Septuagenarians and Octogenarians
In brief
Age 70 or older did not raise free-flap complication rates in limb salvage
In this retrospective study of 318 patients, those aged 70 or older had similar surgical complication rates and overall complication severity to younger patients; acute kidney injury was more common (27.8% vs. 12.9%). Comorbidity burden predicted complications better than age, but the findings come from one center's experience and support individualized risk assessment rather than proving equal safety for every older patient.
- Journal
- Journal of reconstructive microsurgery (Q1)
- Published
- 2 November 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Christopher Michael Ply, Kishan S Shah, Luke J Llaurado, Hannah Soltani, Rachel N Rohrich, Winnie W Li, et al.
- PMID
- 42971256
- DOI
- 10.1055/a-2993-6463
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 8 November 2026): Free-flap limb salvage outcomes in older patients
Abstract
BACKGROUND: As the United States population ages, an increasing number of elderly patients with chronic lower extremity (LE) wounds require reconstruction. Although prior studies have evaluated flap outcomes in elderly patients undergoing free tissue transfer (FTT), systemic postoperative complications and complication severity remain inadequately characterized. This study compared surgical and systemic complications after LE FTT between elderly and non-elderly patients. METHODS: A retrospective review of 318 patients undergoing LE FTT between 2011 and 2024 was performed. Patients were stratified into elderly (≥70 years) and non-elderly (<70 years). Baseline characteristics, vascular status, operative variables, 30-day postoperative complications, and long-term outcomes were analyzed. Thirty-day complications were classified as systemic or surgical and graded using the Clavien-Dindo classification. Logistic regression and receiver operating characteristic analysis were used to evaluate predictors of complications. RESULTS: Of 318 patients, 54 (17.0%) were elderly. Elderly patients experienced similar rates of any systemic complication (33.3% elderly vs. 22.7% non-elderly, p=0.099), although acute kidney injury was more common in elderly patients (27.8% vs. 12.9%, p=0.006). Surgical complications were also similar (33.3% vs. 28.4%, p=0.469). Overall complication severity did not differ between groups (p=0.701), and only 1.6% of patients experienced a life-threatening complication. Smoking history (OR 2.6, p=0.008) and diabetes (OR 2.7, p=0.027) independently predicted major complications, while age did not. The Charlson Comorbidity Index outperformed age in predicting both major (AUC 0.604 vs. 0.539, p=0.031) and minor complications (AUC 0.647 vs. 0.551, p=0.011). Septuagenarians and octogenarians did not differ significantly in complications, ambulation, amputation, or mortality. CONCLUSION: Lower extremity free tissue transfer is a safe and effective limb salvage option in elderly patients, with no difference in systemic or surgical complications. Patient selection and risk assessment for LE FTT should therefore be guided by comorbidity burden rather than chronologic age alone.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.