{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T00:57:28Z","timestamp":1771030648897,"version":"3.50.1"},"reference-count":40,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T00:00:00Z","timestamp":1620950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81871577"],"award-info":[{"award-number":["81871577"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Management of large wounds of the lower extremities remains a challenge for plastic and reconstructive surgeons. Herein, a surgical technique and clinical algorithm using the combined transfer of a latissimus dorsi (LD) musculocutaneous flap and flow\u2010through anterolateral thigh (ALT) perforator flap for the treatment of extensive soft\u2010tissue defects is described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>From January 2012 to September 2018, 12 patients (six men and six women) aged 6\u201337\u2009years, sustained injuries in road traffic accidents with large soft\u2010tissue defects in the lower extremities. Seven cases were Gustillo Anderson type IIIB open fractures and two cases were Gustillo Anderson type IIIC open fractures. Two wounds were located in the knee joint, four in the calf, and six in the ankle and foot. The skin defect size ranged from 25\u2009\u00d7\u200920\u2009cm<jats:sup>2<\/jats:sup> to 36\u2009\u00d7\u200925\u2009cm<jats:sup>2<\/jats:sup>. All patients in this series underwent reconstruction using combined transfer of the LD musculocutaneous flap and flow\u2010through ALT perforator flap, wherein the LD was attached through its pedicle to the distal continuation of the ALT flap.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The size of the flow\u2010through ALT perforator flaps ranged from 13.5\u2009\u00d7\u20096.5\u00a0cm<jats:sup>2<\/jats:sup> to 31\u2009\u00d7\u20098.5\u00a0cm<jats:sup>2<\/jats:sup>. The size of the LD musculocutaneous skin paddle ranged from 25\u2009\u00d7\u20096\u00a0cm<jats:sup>2<\/jats:sup> to 34\u2009\u00d7\u20097\u00a0cm<jats:sup>2<\/jats:sup>, and that of the muscle paddle ranged from 13\u2009\u00d7\u20093.5\u00a0cm<jats:sup>2<\/jats:sup> to 30\u2009\u00d7\u200911\u2009cm<jats:sup>2<\/jats:sup>. One patient experienced postoperative thrombosis of the venous pedicle, and the flap was salvaged after emergency re\u2010exploration and thrombectomy. No other complications were observed postoperatively. The mean follow\u2010up period was 26.8\u00a0months. All patients were able to ambulate independently at the end of the follow\u2010up period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The combined transfer of the LD musculocutaneous flap and flow\u2010through ALT perforator flap ensured adequate surface coverage, making it a feasible procedure for large soft\u2010tissue defects.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30754","type":"journal-article","created":{"date-parts":[[2021,5,14]],"date-time":"2021-05-14T15:36:52Z","timestamp":1621006612000},"page":"533-542","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Large wounds reconstruction of the lower extremity with combined latissimus dorsi musculocutaneous flap and flow\u2010through anterolateral thigh perforator flap transfer"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9827-6897","authenticated-orcid":false,"given":"Jiqiang","family":"He","sequence":"first","affiliation":[{"name":"Department of Hand and Microsurgery Xiangya Hospital of Central South University  Changsha Hunan Province China"},{"name":"Department of Plastic and Reconstructive Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liming","family":"Qing","sequence":"additional","affiliation":[{"name":"Department of Hand and Microsurgery Xiangya Hospital of Central South University  Changsha Hunan Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panfeng","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Hand and Microsurgery Xiangya Hospital of Central South University  Changsha Hunan Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhengbing","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Hand and Microsurgery Xiangya Hospital of Central South University  Changsha Hunan Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Hand and Microsurgery Xiangya Hospital of Central South University  Changsha Hunan Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4956-0573","authenticated-orcid":false,"given":"Juyu","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Hand and Microsurgery Xiangya Hospital of Central South University  Changsha Hunan Province China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,5,14]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002476"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199512000-00014"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"S03","DOI":"10.1055\/s-0037-1603737","article-title":"Limb and flap salvage in Gustilo IIIC injuries treated by vascular repair and emergency free flap transfer","volume":"33","author":"Arnez Z. 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