{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:50:06Z","timestamp":1791615006738,"version":"4.3.4"},"reference-count":47,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronological age inadequately reflects physiologic vulnerability in older adults undergoing complex reconstruction. Frailty, quantified by the 5\u2010item Modified Frailty Index (mFI\u20105), may better stratify perioperative risk in fibula free flap (FFF) reconstruction for head and neck defects, but its impact remains underdefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study of 406 adults undergoing FFF reconstruction (ACS\u2010NSQIP, 2009\u20132023) evaluated the association between mFI\u20105 and 30\u2010day postoperative outcomes. Multivariable logistic regression identified independent predictors of medical and surgical complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher mFI\u20105 scores were associated with increased medical complications (14.1% mFI\u20105\u2009=\u20090 vs. 34.3% mFI\u20105\u2009=\u20092;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), including pneumonia and myocardial infarction. mFI\u20105\u2009=\u20091 (aOR 1.84; 95% CI, 1.01\u20133.47) and mFI\u20105\u2009=\u20092 (aOR 3.45; 95% CI, 1.38\u20138.57) independently predicted medical complications; mFI\u20105\u2009=\u20092 also predicted surgical complications (aOR 2.27; 95% CI, 1.00\u20135.43).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Frailty is a stronger predictor of postoperative morbidity than chronological age. Incorporating frailty assessment may enhance risk stratification and perioperative decision\u2010making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70301","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:23:01Z","timestamp":1791613381000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Frailty as a Predictor of Outcomes After Fibula Free Flap for Head and Neck Reconstruction: A Multi\u2010Institutional Analysis Using the\n                    <scp>mFI<\/scp>\n                    \u20105"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6121-1834","authenticated-orcid":false,"given":"Jia Wei","family":"Tee","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology University Health Network  Toronto Canada"},{"name":"Department of Hand, Plastic and 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Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3065-4352","authenticated-orcid":false,"given":"Tobias","family":"Niederegger","sequence":"additional","affiliation":[{"name":"Medical Faculty University of Heidelberg  Heidelberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iman","family":"Ghanad","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt\u2010Universit\u00e4t Zu Berlin, and Berlin Institute of Health  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard","family":"Knoedler","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt\u2010Universit\u00e4t Zu Berlin, and Berlin Institute of Health  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5798-8003","authenticated-orcid":false,"given":"Samuel","family":"Knoedler","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8279-7310","authenticated-orcid":false,"given":"Dennis P.","family":"Orgill","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery Brigham and Women's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1935-3546","authenticated-orcid":false,"given":"Henri","family":"Kreiker","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt\u2010Universit\u00e4t Zu Berlin, and Berlin Institute of Health  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Rendenbach","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt\u2010Universit\u00e4t Zu Berlin, and Berlin Institute of Health  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4987-2913","authenticated-orcid":false,"given":"Max","family":"Heiland","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt\u2010Universit\u00e4t Zu Berlin, and Berlin Institute of Health  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6173-8602","authenticated-orcid":false,"given":"Gabriel","family":"Hundeshagen","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Reconstructive Surgery Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg  Ludwigshafen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4053-9855","authenticated-orcid":false,"given":"Adriana C.","family":"Panayi","sequence":"additional","affiliation":[{"name":"Department of Cranio\u2010Maxillofacial and Oral Surgery University Hospital Zurich, University of Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"AAPC.2025.\u201cCPT 20955 Under Other Procedures on the 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