Abstract
In an ageing population, increasing numbers of patients over the age of 70 are sustaining severe trauma. These patients require careful multidisciplinary team (MDT) management with careful consideration of existing co-morbidities, as such their treatment should be individually tailored. We present the case of a patient believed to be the oldest documented patient treated in a trauma setting with free flap and circular frame fixation to an open tibial fracture. A 95-year-old male presented to the Level 1 Major Trauma Centre (MTC) with multiple injuries after a pedestrian vs car incident. His injury severity score (ISS) was 22. For treatment of his open tibial fracture, he required soft tissue coverage with a free anterolateral thigh (ALT) flap, and circular frame application. Microsurgery was performed after consultation with the MDT and was uneventful. The circular frame was removed after 10 months and the patient went on to regain pre-injury mobility. Use of free tissue transfer in elderly patients is well documented in the elective setting, but less so in trauma. This case demonstrates that careful patient selection, attention to detail and MDT working can result in an excellent outcome for the patient. The challenges faced in treating this patient will be described in detail.Level of Evidence: Level V, therapeutic study.
Highlights
As the population of the UK ages, medical professionals will need to perform interventions on patients that we are yet to gain experience of
Two series recently published by Sierkowski et al [3] and Mitchell et al [4] concentrate on free flaps in the elderly
We report the oldest patient in the literature to receive a free flap following trauma to the lower limb
Summary
As the population of the UK ages, medical professionals will need to perform interventions on patients that we are yet to gain experience of. The case that follows is of a 95-year-old male who required a free anterolateral thigh (ALT) flap for coverage of an open traumatic tibia and fibula fracture of the right leg. This gentleman received a circular frame for treatment of his fracture. The second procedure on day 5 post-injury was primary tibial shortening following further bony debridement, and free ALT flap, following which the patient remained on HDU for 2 further days as per local protocol. The frame was removed at 10 months (see Figs. 3 and 4) and at 15 months he weightbears without a cast or boot and has resumed his pre-injury activities with excellent soft tissue cover
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
