Free flaps for lower limb soft tissue reconstruction-A systematic review of complications in 'Silver Trauma' patients

Background: There are 12.5 million people aged 65 years and older living in the UK. The annual incidence of open fracture is 30.7 per 10,0 0 0 person-years. In females, 42.9% of all open fractures occur in patients >= 65 years.Methods and materials: Preferred Reporting for Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study is registered with PROSPERO (CRD42020209149). The aim was to compare the complication profiles of free fasciocutaneous flaps and free muscular flaps in patients aged over 60 years undergoing lower limb soft tissue reconstruction following an open lower limb fracture. The search strategy based on strict inclusion criteria included PubMed, Embase and Google Scholar. Results: 15 papers were identified, including 46 patients with 10 free fasciocutaneous flaps and 41 free muscle flaps. There were 3 complications in the fasciocutaneous group (30%) and 9 complications in the muscle group (22%). There was a total of 1 secondary procedure in the fasciocutaneous group and 4 in the muscle group.Discussion: There is insufficient data to provide statistical comparison between free fasciocutaneous ver-sus free muscle flaps for lower limb reconstruction performed in those aged over 60 years. This sys-tematic review highlights evidence for the successful use of free tissue transfer in the older population following an open fracture injury and requiring lower limb reconstruction. There is no evidence to sug-gest the superiority of one tissue type over the other, with the inference that well vascularised tissue is the most significant factor impacting outcome.(c) 2023 Elsevier Ltd. All rights reserved.