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Beitragstitel Microsurgical Reconstruction of the Lower Extremity in the Elderly
Beitragscode P41
  1. Rik Osinga Universitätsspital Basel Vortragender
  2. Andreas Gohritz Universitätsspital Basel
  3. Martin Clauss University Hospital Basel, Switzerland
  4. Dirk Schaefer Universitätsspital Basel
Präsentationsform Poster
  • A06 - Fuss
Abstract Indication
Individuals of advanced age are the fastest growing subpopulation with an increasing incidence of complex lower extremity wounds. Historically, elderly patients were discouraged from microsurgical reconstructions because of medical comorbidities and lack of organ system reserve to withstand the lengthy and physically demanding intervention. The purpose of this article is to discuss strategies for microsurgical reconstruction of the lower extremity in the elderly population and to further reduce perioperative and postoperative risks and complications providing good functional results.

Based on a single centre experience and illustrated by four comprehensive case examples, indications, contraindications, preoperative evaluation and special considerations (including age vs. frailty, treatment objectives, principles and strategy, decision making, preoperative patient evaluation, perioperative management, preoperative planning and imaging), the surgical procedure itself, postoperative care and management of complications are discussed.

A multidisciplinary team approach makes microsurgery a safe and succesful procedure. Age-related pathologies (atherosclerosis above all) demand thorough preoperative planning. Intraoperative stress can be reduced by regional anaesthesia, a sitting position (beach-chair) and a short operative time through a two-team approach. Reliable workhorse flaps provide easy vascular access with limited incisions, reliable anatomy and long vascular pedicles for speedy and safe soft-tissue reconstruction. Postoperative intensive/intermediate care helps to detect and manage complications early, provide immediate interventions and avoid fast deterioration due to limited physiological reserve. Early flap dangling and mobilization minimize sequelae of prolonged immobilization and support rapid functional and social reintegration.

Microsurgical reconstruction in the lower extremity can be performed safely with high success rates and manageable complications in elderly patients. The prerequisites include (i) a comprehensive preoperative interdisciplinary assessment of the patient and optimization of risk factors, (ii) meticulous preoperative planning, (iii) intraoperative adaptation of anesthesia and efficient surgical technique, and (iv) specialized postoperative monitoring and early mobilization according to the specific needs of the elderly patient.