{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T08:00:52Z","timestamp":1779264052485,"version":"3.51.4"},"reference-count":18,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,4,23]],"date-time":"2023-04-23T00:00:00Z","timestamp":1682208000000},"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":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Tumors affecting the perineal region are a subtle and difficult to diagnose type of malignancy. In particular, soft tissue sarcomas (STS) may be already very large at time of diagnosis, thus impairing a normal life. In such severe cases, debulking surgery is the only possibility to offer the patient an acceptable quality of life again. These procedures inevitably result in massive defects. Depending on the affected area, there are different reconstructive options available so far, and sometimes a combination of multiple flaps is required. With the present report, we would like to share our experience with a complex genital and perineal defect. A 75\u2010year\u2010old patient presenting a massive epithelioid sarcoma in the ischio\u2010rectal and anal fossae underwent a surgical excision with safe margins, which included the resection of the external genitalia, the pubis, and the rectum. The end result of this procedure was a massive defect measuring 31\u2009cm (length)\u2009\u00d7\u20098\u2009cm (width)\u2009\u00d7\u20096\u2009cm (depth). To accomplish the requirements of this particular case we planned to utilize mostly the nearby tissues. The reconstruction was performed layer by layer. We resorted to a pedicled chimeric anterolateral thigh (ALT) flap measuring 8\u2009cm\u2009\u00d7\u20096\u2009cm, with a large amount of the vastus lateralis (20\u2009cm\u2009\u00d7\u20098\u2009cm) to fill the deeper defect, and a duplicated fascia lata (20\u2009cm\u2009\u00d7\u20096\u2009cm) to restore the abdominal support of the pubis. Then the external coverage was completed combining a pedicled superficial circumflex (SCIP) flap measuring 9\u2009cm\u2009\u00d7\u20098\u2009cm, a pedicled gracilis flap measuring 27\u2009cm\u2009\u00d7\u20094\u2009cm and a pedicled posteromedial thigh (PMT) flap measuring 22\u2009cm\u2009\u00d7\u20098\u2009cm harvested in vertical fashion. The postoperative course was uneventful, and at 6\u2009months follow up the reconstructive result was successful with a stable soft tissue coverage and no complaints from the patient. With the present case report, we would like to show the importance of mastering different reconstructive procedures, whose combination might be the only solution to cover very large and complex defects.<\/jats:p>","DOI":"10.1002\/micr.31051","type":"journal-article","created":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T04:02:07Z","timestamp":1682308927000},"page":"842-846","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Combination of four pedicled flaps for multilayer reconstruction of massive pelvic defect: A case report"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5289-9140","authenticated-orcid":false,"given":"Mario F.","family":"Scaglioni","sequence":"first","affiliation":[{"name":"Department of Hand\u2010 and Plastic Surgery Luzerner Kantonsspital  Lucerne Switzerland"},{"name":"Department of Health Sciences and Medicine University of Lucerne  Lucerne Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matteo","family":"Meroni","sequence":"additional","affiliation":[{"name":"Department of Hand\u2010 and Plastic Surgery Luzerner Kantonsspital  Lucerne Switzerland"},{"name":"Department of Health Sciences and Medicine University of Lucerne  Lucerne Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Department of Health Sciences and Medicine University of Lucerne  Lucerne Switzerland"},{"name":"Department of Orthopedic Surgery Luzerner Kantonsspital  Lucerne Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,4,23]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181bcf05c"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(01)01646-7"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22442"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22037"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197011)26:5<1029::AID-CNCR2820260510>3.0.CO;2-R"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-199702000-00002"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(11)63000-0"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30152"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30008"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30157"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001414"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30933"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30723"},{"issue":"5","key":"e_1_2_6_15_1","first-page":"49","article-title":"Epithelioid sarcoma: A review and update","volume":"2","author":"Sobanko J. F.","year":"2009","journal-title":"The Journal of Clinical and Aesthetic Dermatology"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2022.04.008"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.5999\/aps.2016.43.5.446"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2004.06.003"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30544"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.31051","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T21:05:00Z","timestamp":1700082300000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.31051"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,23]]},"references-count":18,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1002\/micr.31051"],"URL":"https:\/\/doi.org\/10.1002\/micr.31051","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,23]]},"assertion":[{"value":"2022-12-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}