{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T10:01:55Z","timestamp":1753869715701,"version":"3.41.2"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T00:00:00Z","timestamp":1726790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Lower extremity (LE) reconstruction in the elderly population presents a multifaceted challenge, primarily due to age\u2010related 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients \u2265\u200918\u2009years who underwent post\u2010traumatic 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 (\u2265\u200960\u2009years old) and the control (&lt;\u200960\u2009years old) cohorts were recorded. The primary outcome was final ambulation status, modeled with logistic regression. Secondary outcomes included postoperative complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean ages of the control (<jats:italic>n<\/jats:italic>\u2009=\u2009374) and elderly (<jats:italic>n<\/jats:italic>\u2009=\u200949) groups were 37.4\u2009\u00b1\u200912.6 and 65.8\u2009\u00b1\u20095.1\u2009years, respectively. Elderly patients more frequently required amputation after flap surgery (<jats:italic>p<\/jats:italic>\u2009=\u20090.002). There was no significant difference between the two cohorts in preoperative ambulation status (<jats:italic>p<\/jats:italic>\u2009=\u20090.053). Postoperatively, 22.4% of elderly patients were independently ambulatory at final follow\u2010up, compared to 49.5% of patients &lt;\u200960. 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 &lt;\u200960\u2009years of age (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Multivariate regression confirmed an association between older age and nonambulatory final status (<jats:italic>p<\/jats:italic>\u2009=\u20090.033).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>LE reconstruction can likely be performed safely in patients 60\u2009years 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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.31239","type":"journal-article","created":{"date-parts":[[2024,9,20]],"date-time":"2024-09-20T10:43:52Z","timestamp":1726829032000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flap\u2010Based Lower Extremity Reconstruction in the Elderly\u2014Is It Safe and Does Age Impact Ambulation?"],"prefix":"10.1002","volume":"44","author":[{"given":"Artur","family":"Manasyan","sequence":"first","affiliation":[{"name":"Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0063-8584","authenticated-orcid":false,"given":"Eloise\u00a0W.","family":"Stanton","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Keck School of Medicine of USC  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin","family":"Wolfe","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Keck School of Medicine of USC  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph\u00a0N.","family":"Carey","sequence":"additional","affiliation":[{"name":"Keck School of Medicine University of Southern California  Los Angeles California USA"},{"name":"Division of Plastic and Reconstructive Surgery Keck School of Medicine of USC  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David\u00a0A.","family":"Daar","sequence":"additional","affiliation":[{"name":"Keck School of Medicine University of Southern California  Los Angeles California USA"},{"name":"Division of Plastic and Reconstructive Surgery Keck School of Medicine of USC  Los Angeles California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,9,20]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_8_2_1","DOI":"10.18203\/2394\u20106040.ijcmph20174840"},{"doi-asserted-by":"publisher","key":"e_1_2_8_3_1","DOI":"10.1016\/j.injury.2020.02.060"},{"doi-asserted-by":"publisher","key":"e_1_2_8_4_1","DOI":"10.1097\/DSS.0000000000000330"},{"doi-asserted-by":"publisher","key":"e_1_2_8_5_1","DOI":"10.1016\/j.cpm.2020.07.002"},{"doi-asserted-by":"publisher","key":"e_1_2_8_6_1","DOI":"10.1016\/j.jbspin.2021.105135"},{"doi-asserted-by":"publisher","key":"e_1_2_8_7_1","DOI":"10.1016\/s0169\u20106009(08)80203\u20106"},{"doi-asserted-by":"publisher","key":"e_1_2_8_8_1","DOI":"10.1016\/j.amjsurg.2015.12.018"},{"doi-asserted-by":"publisher","key":"e_1_2_8_9_1","DOI":"10.1016\/j.apmr.2008.01.032"},{"doi-asserted-by":"publisher","key":"e_1_2_8_10_1","DOI":"10.3390\/ijerph19010207"},{"doi-asserted-by":"publisher","key":"e_1_2_8_11_1","DOI":"10.1097\/SAP.0000000000002041"},{"doi-asserted-by":"publisher","key":"e_1_2_8_12_1","DOI":"10.1016\/S0094-1298(20)31990-8"},{"doi-asserted-by":"publisher","key":"e_1_2_8_13_1","DOI":"10.1016\/j.injury.2020.04.050"},{"doi-asserted-by":"publisher","key":"e_1_2_8_14_1","DOI":"10.1097\/01.sap.0000135138.45902.52"},{"doi-asserted-by":"publisher","key":"e_1_2_8_15_1","DOI":"10.1016\/S0733-8635(18)30227-4"},{"doi-asserted-by":"publisher","key":"e_1_2_8_16_1","DOI":"10.1016\/j.cps.2021.01.008"},{"doi-asserted-by":"publisher","key":"e_1_2_8_17_1","DOI":"10.1007\/s00268\u2010003\u20107397\u20106"},{"doi-asserted-by":"publisher","key":"e_1_2_8_18_1","DOI":"10.1016\/j.archger.2010.06.004"},{"doi-asserted-by":"publisher","key":"e_1_2_8_19_1","DOI":"10.1007\/s00064\u2010012\u20100197\u20100"},{"doi-asserted-by":"publisher","key":"e_1_2_8_20_1","DOI":"10.1016\/j.jamda.2009.06.002"},{"volume-title":"StatPearls","year":"2023","author":"Keen M. 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