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Background: Increased lifespan and the improvement of medical treatment have given rise to research in reconstructive procedures in elderly patients. Higher postoperative complication rates, longer rehabilitation, and surgical difficulties remain a problem in the elderly. We asked whether a free flap in elderly patients is an indication or a contraindication and performed a retrospective, monocentric study., Methods: Patients were divided into two groups (YOUNG 0-59 years; OLD > 60 years). The endpoint was the survival of flaps and their dependence on patient- and surgery-specific parameters using multivariate analysis., Results: A total of 110 patients (OLD n = 59) underwent 129 flaps. The chance of flap loss increased as soon as two flaps were performed in one surgery. Anterior lateral thigh flaps had the highest chance for flap survival. Compared with the lower extremity, the head/neck/trunk group had a significantly increased chance of flap loss. There was a significant increase in the odds of flap loss in linear relation to the administration of erythrocyte concentrates., Conclusion: The results confirm that free flap surgery can be indicated as a safe method for the elderly. Perioperative parameters such as two flaps in one surgery and transfusion regimens must be considered as risk factors for flap loss.

Artificial tissue substitutes are of great interest for the reconstruction of destroyed and non-functional skin or bone tissue due to its scarcity. Biomaterials used as scaffolds for tissue regeneration are non-vascularized synthetic tissues and often based on polymers, which need ingrowth of new blood vessels to ensure nutrition and metabolism. This review summarizes previous approaches and highlights advances in vascularization strategies after implantation of surface-modified biomaterials for skin and bone tissue regeneration. The efficient integration of biomaterial, bioactive coating with endogenous degradable matrix proteins, physiochemical modifications, or surface geometry changes represents promising approaches. The results show that the induction of angiogenesis in the implant site as well as the vascularization of biomaterials can be influenced by specific surface modifications. The neovascularization of a biomaterial can be supported by the application of pro-angiogenic substances as well as by biomimetic surface coatings and physical or chemical surface activations. Furthermore, it was confirmed that the geometric properties of the three-dimensional biomaterial matrix play a central role, as they guide or even enable the ingrowth of blood vessels into a biomaterial.

Wounds and tissue defects of the hand and foot often lead to severe functional impairment of the affected extremity. Next to general principles of wound healing, special functional and anatomic considerations must be taken into account in the treatment of wounds in these anatomical regions to achieve a satisfactory reconstructive result. In this article, we outline the concept of wound healing and focus on the special aspects to be considered in wounds of the hand and foot. An overview of different treatment and dressing techniques is given with special emphasis on the reconstruction of damaged structures by plastic surgical means.

A large number of models are now available for the investigation of skin wound healing. These can be used to study the processes that take place in a phase-specific manner under both physiological and pathological conditions. Most models focus on wound closure, which is a crucial parameter for wound healing. However, vascular supply plays an equally important role and corresponding models for selective or parallel investigation of microcirculation regeneration and angiogenesis are also described. In this review article, we therefore focus on the different levels of investigation of skin wound healing (in vivo to in virtuo) and the investigation of angiogenesis and its parameters.