{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T05:16:28Z","timestamp":1767676588460,"version":"3.40.5"},"reference-count":19,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,5,7]],"date-time":"2018-05-07T00:00:00Z","timestamp":1525651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:p>Early soft\u2010tissue coverage is critical for treating traumatic open lower\u2010extremity wounds. As free\u2010flap reconstruction evolves, injuries once thought to be nonreconstructable are being salvaged. Free\u2010tissue transfer is imperative when there is extensive dead space or exposure of vital structures such as bone, tendon, nerves, or blood vessels. We describe 2 cases of lower\u2010extremity crush injuries salvaged with the quad flap. This novel flap consists of parascapular, scapular, serratus, and latissimus dorsi free flaps in combination on one pedicle. This flap provides the large amount of soft\u2010tissue coverage necessary to cover substantial defects from skin degloving, tibia and fibula fractures, and soft\u2010tissue loss. In case 1, a 51\u2010year\u2010old woman was struck by an automobile and sustained bilateral tibia and fibula fractures, a crush degloving injury of the left leg, and a right forefoot traumatic amputation. She underwent reconstruction with a contralateral quad free flap. In case 2, a 53\u2010year\u2010old man sustained a right tibia plateau fracture with large soft\u2010tissue defects from a motorcycle accident. He had a crush degloving injury of the entire anterolateral compartment over the distal and lower third of the right leg. The large soft\u2010tissue defect was reconstructed with a contralateral quad flap. In both cases, the donor site was closed primarily and without early flap failures. There was one surgical complication, an abscess in case 2; the patient was taken back to the operating room for d\u00e9bridement of necrotic tissue. There have been no long\u2010term complications in either case. Both patients achieved adequate soft\u2010tissue coverage, avoided amputation, and had satisfactory aesthetic and functional outcomes. With appropriate surgical technique and patient selection, the quad\u2010flap technique is promising for reconstructing the lower extremity.<\/jats:p>","DOI":"10.1002\/micr.30335","type":"journal-article","created":{"date-parts":[[2018,5,8]],"date-time":"2018-05-08T05:24:41Z","timestamp":1525757081000},"page":"182-187","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Lower\u2010limb reconstruction with chimeric flaps: The quad flap<sup>*<\/sup>"],"prefix":"10.1002","volume":"39","author":[{"given":"Solomon M.","family":"Azouz","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Mayo Clinic Hospital Phoenix Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikki A.","family":"Castel","sequence":"additional","affiliation":[{"name":"Mayo Clinic School of Medicine, Mayo Clinic College of Medicine and Science Rochester Minnesota"},{"name":"Division of Plastic and Reconstructive Surgery Rutgers New Jersey Medical School Newark New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6143-1849","authenticated-orcid":false,"given":"Aparna","family":"Vijayasekaran","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Mayo Clinic Rochester Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alanna M.","family":"Rebecca","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Mayo Clinic Hospital Phoenix Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4449-620X","authenticated-orcid":false,"given":"Salvatore C.","family":"Lettieri","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery Mayo Clinic Hospital Phoenix Arizona"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,5,7]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"Astik R. &Dave U.(2016). 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