{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T08:51:40Z","timestamp":1776588700407,"version":"3.51.2"},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2019,8,23]],"date-time":"2019-08-23T00:00:00Z","timestamp":1566518400000},"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":[[2019,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Free flaps can be options for coverage of radiation ulcers. However, due to radiation damage, it may be hard to find and dissect a reliable recipient vessel for microsurgical anastomosis. When the radiation fields are targeted for deep tissues, superficial tissues may be less affected by radiation. Therefore, damage to perforator vessels near the skin may be lesser than that to the major vessels in deeper structures. We would like to introduce our experiences of using these less injured perforating vessels within or near the wound as recipient vessels for free flap coverage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods<\/jats:title><jats:p>From 2013 to 2015, 11 patients underwent free flap coverage for the treatment of radiation\u2010induced ulceration. The location of ulcers were three cases of thigh, two cases of inguinal area, axilla, trochanteric area, chest wall, lower leg, perineal area, and back. Eleven cases were reconstructed using the anterolateral thigh (ALT) perforator flap, and in one case, the thoracodorsal artery perforator (TDAP) flap was used for inguinal area defect. With preoperative computed tomography, we found perforating vessels around the radiation ulcer. The perforating vessels that were identified before the operation were detected by hand\u2010held Doppler during the operation and meticulous dissection was performed. In all\u2010cases, the perforating vessels were accompanied by vena commitantes. A reliable perforator is one with visible pulsation, strong sound detected on Doppler, and sufficient diameter, preferably larger than 0.6\u2009mm. Anastomosis was performed after confirming that the blood vessel was reliable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The flap sizes ranged from 7\u2009\u00d7\u20096 cm to 24\u2009\u00d7\u200910 cm. No flap total necrosis developed. Patients were followed in the outpatient clinic for 21 to 31\u2009months postoperatively. No patients experienced recurrence of ulceration during the follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In free flap reconstruction of radiation ulcers, using perforating vessels within or outside the ulcer as recipient vessels provided less damaged vessels and healthier flaps for the defects with minimal wound complications. These perforating vessels can be a good option as recipient vessel for free flap coverage of radiation ulcers.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30504","type":"journal-article","created":{"date-parts":[[2019,8,23]],"date-time":"2019-08-23T07:30:36Z","timestamp":1566545436000},"page":"613-620","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Reconstruction of radiation\u2010induced ulcers with free flaps using the perforating vessel as a recipient vessel"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9819-0775","authenticated-orcid":false,"given":"Ji Min","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Seoul St. Mary's hospital College of Medicine The Catholic University of Korea  Seocho\u2010gu Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seong Ae","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Seoul St. Mary's hospital College of Medicine The Catholic University of Korea  Seocho\u2010gu Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyo Jeong","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Seoul St. Mary's hospital College of Medicine The Catholic University of Korea  Seocho\u2010gu Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suk\u2010Ho","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Seoul St. Mary's hospital College of Medicine The Catholic University of Korea  Seocho\u2010gu Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3499-1554","authenticated-orcid":false,"given":"Deuk Young","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Seoul St. Mary's hospital College of Medicine The Catholic University of Korea  Seocho\u2010gu Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jong Won","family":"Rhie","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Seoul St. Mary's hospital College of Medicine The Catholic University of Korea  Seocho\u2010gu Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young\u2010Joon","family":"Jun","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Seoul St. Mary's hospital College of Medicine The Catholic University of Korea  Seocho\u2010gu Seoul Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,8,23]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"155","article-title":"Volume effect & normal tissue responses","volume":"2","author":"Baltas D.","year":"1997","journal-title":"Modeling in Clinical Radiobiology Freiburg Oncology Series, Monograph"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2009.01.081"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/09553002.2011.611213"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2017.02.021"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1089\/wound.2012.0405"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/09553007714551481"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.12888"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181904dc4"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.25243"},{"key":"e_1_2_9_11_1","first-page":"6","article-title":"Volume effects in radiobiology as applied to radiotherapy","volume":"56","author":"John William Hopewel K.\u2010R. 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