Latissimus dorsi free flaps in the elderly: an alternative to below-knee amputation.

The purpose of this paper is to document that free-flap surgery may be applied in specific circumstances to elderly patients with extensive vascular insufficiency and wound coverage problems. Below-knee amputation may be a direct but not necessarily desirable answer to the elderly patient with these problems. The problems of increased energy of ambulation, prosthetic fit, and psychological depression are all accentuated in the elderly. Three free-flap patients of an average age of 80 are presented with successful wound coverage, control of ischemic pain, and early return to an independent ambulatory state. The latissimus free flap seems to be an appropriate tool for this purpose. The T-pedicle is especially suited to bridge segmental vascular deficits seen in this population. We conclude that in specific situations, this approach may be an alternative to amputation in the elderly.