{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:26:36Z","timestamp":1787837196785,"version":"build-2784847793"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,12,25]],"date-time":"2020-12-25T00:00:00Z","timestamp":1608854400000},"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":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Reconstruction of a complex knee defect is challenging, especially when complicated with osteomyelitis. Complex knee defect requires multi\u2010component three\u2010dimensional reconstruction using a chimeric flap. Although anterolateral thigh (ALT) flap is the most workhorse chimeric flap, another chimeric flap is required when ALT flap is not available. In this report, we present a case of complex knee defect successfully treated with a free triple\u2010component chimeric deep inferior epigastric artery perforator (DIEP) flap transfer. A 36\u2009year\u2010old male sustained right above\u2010knee amputation and Gustilo IIIB open fracture of the left patella after being run over by a train. Stump formation was performed for the right limb amputation, and the left knee wound resulted in skin necrosis complicated with patella osteomyelitis. After debridement, the left knee wound showed a 3\u2009\u00d7\u20092 cm articular capsule defect, 5\u2009\u00d7\u20092 cm exposed patella stump, and a 16\u2009\u00d7\u20099 cm skin defect. A triple\u2010component chimeric DIEP flap, containing a 7\u2009\u00d7\u20093 cm rectus abdominis muscle (RAM), a 3\u2009\u00d7\u20092 cm RAM's fascia, and a 23\u2009\u00d7\u200910 cm skin was transferred. The RAM's fascia was used to reconstruct the joint, the RAM to cover the exposed patella's stump and the reconstructed joint, and the skin paddle to cover the skin defect. Six months after the surgery, the patient could walk without osteomyelitis recurrence, and there was no limitation in the left knee joint's range of motion. Although indication is limited, a multi\u2010component chimeric DIEP flap may be an option for three\u2010dimensional reconstruction of a complex defect.<\/jats:p>","DOI":"10.1002\/micr.30698","type":"journal-article","created":{"date-parts":[[2020,12,25]],"date-time":"2020-12-25T12:36:01Z","timestamp":1608899761000},"page":"370-375","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A <scp>triple\u2010component<\/scp> deep inferior epigastric artery perforator chimeric free flap for <scp>three\u2010dimensional<\/scp> reconstruction of a complex knee defect complicated with patella osteomyelitis"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9223-5987","authenticated-orcid":false,"given":"Takumi","family":"Yamamoto","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Center Hospital of National Center for Global Health and Medicine  Tokyo 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Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,12,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22438"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1054\/bjps.1998.3033"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31815b2792"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0b013e31818b4cc4"},{"issue":"6","key":"e_1_2_7_6_1","first-page":"425","article-title":"Application of free chimeric perforator flap with deep epigastric inferior artery for the soft tissue defect on the lower extremity with deep dead space","volume":"31","author":"Juyu T.","year":"2015","journal-title":"Zhonghua Zheng Xing Wai Ke Za 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