{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T04:12:26Z","timestamp":1781323946953,"version":"3.54.1"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,8,23]],"date-time":"2013-08-23T00:00:00Z","timestamp":1377216000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:p><jats:italic>Background<\/jats:italic>: The Iraq and Afghanistan Wars have presented military reconstructive surgeons with a high volume of challenging extremity injuries. In recent years, a number of upper and lower extremity injuries requiring multiple tissue transfers for multiple limb salvages in the same casualty have been encountered. Our group will discuss the microsurgical challenges, algorithms, and success and complication rates for this cohort of war injured patients. <jats:italic>Methods<\/jats:italic>: All consecutive limb salvage cases requiring free flaps from 2003 to 2012 were reviewed. Cases involving simultaneous free tissue transfers were identified. Data collected included success rates and complications with comparisons made between the single and multiple free\u2010flap limb salvage cohorts. <jats:italic>Results<\/jats:italic>: Seventy\u2010four free flap limb salvage cases were performed over the 10\u2010year period. Of these cases, four patients received two free flaps to separate upper and lower extremity injuries for limb salvage within a single operative setting. The complication rate was 63%, which was significantly higher than those cases in which a single microvascular anastomosis was performed (26%, <jats:italic>p<\/jats:italic> = 0.046). However, the higher complication rate did not increase the flap or limb salvage failure rates (<jats:italic>p<\/jats:italic> = 0.892 and 0.626). <jats:italic>Conclusions<\/jats:italic>: The last decade of war trauma has provided a high volume of extremity injuries requiring limb salvage procedures including casualties who underwent single and multiple free flap coverage procedures. Although multiple flap limb salvage procedures have a higher complication rate, they can be performed within the same patient without concern for increased failure rate in carefully selected and appropriately managed patients. \u00a9 2013 Wiley Periodicals, Inc. Microsurgery 33:447\u2013453, 2013.<\/jats:p>","DOI":"10.1002\/micr.22145","type":"journal-article","created":{"date-parts":[[2013,8,23]],"date-time":"2013-08-23T06:52:39Z","timestamp":1377240759000},"page":"447-453","source":"Crossref","is-referenced-by-count":10,"title":["Sequential free tissue transfers for simultaneous upper and lower limb salvage"],"prefix":"10.1002","volume":"33","author":[{"given":"Ian L.","family":"Valerio","sequence":"first","affiliation":[{"name":"Walter Reed National Military Medical Center Bethesda MD"},{"name":"Division of Plastic and Reconstructive Surgery University of Pittsburgh Medical Center Pittsburgh PA"},{"name":"Department of Plastic and Reconstructive Surgery The Johns Hopkins University School of Medicine Baltimore MD"},{"name":"The Uniformed Services University of the Health Sciences Bethesda MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Sabino","sequence":"additional","affiliation":[{"name":"Walter 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