{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T12:28:35Z","timestamp":1780921715172,"version":"3.54.1"},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T00:00:00Z","timestamp":1694217600000},"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>Patients with large defects after oncologic surgery often require enhanced surgical planning to optimize reconstructive outcomes. As such, medically complex patients require innovative solutions when utilizing abdominal flaps due to concern for ischemia of the distal tissue. Vascular augmentations, such as supercharging or turbocharging, serve to increase perfusion in these medical complex patients to ensure flap survival. In this report, we highlight the use of a supercharged bilateral pedicled deep inferior epigastric perforator (DIEP) flap in a patient with a 231\u2009cm<jats:sup>2<\/jats:sup> thigh defect in the setting of uncontrolled diabetes. A 57\u2010year\u2010old male with poorly\u2010controlled diabetes (blood sugar prior to surgery 510\u2009mg\/dL) and iron deficiency anemia presented with a two\u2010year history of a large nonmetastatic squamous cell carcinoma (SCC) measuring 19\u2009\u00d7\u20099\u2009cm<jats:sup>2<\/jats:sup> on the right thigh. Positron emission tomography\/computed tomography and biopsies of the right retroperitoneal and inguinal lymph nodes diagnosed the mass as Stage 3 localized SCC. After excision, we performed immediate reconstruction of the resultant defect with a supercharged bilateral pedicled DIEP flap. The flap was pedicled on the ipsilateral DIEP and the contralateral perforator was anastomosed to the descending branch of the lateral circumflex femoral artery (DLCFA) at the inferior aspect of the defect. A venous coupler was used for the veins and the arteries were hand\u2010sewn in end\u2010to\u2010end fashion. The supercharged bilateral pedicled DIEP flap was utilized for enhanced augmented perfusion to the distal edge of the pedicled flap in a high\u2010risk patient. The patient's clinical course was complicated by a <jats:italic>Pseudomonas<\/jats:italic> infection of a small hematoma requiring operative washout and debridement of necrotic fat. However, the flap survived and covered the defect completely. The patient required outpatient antibiotics for the <jats:italic>Pseudomonas<\/jats:italic> infection which resolved completely without further need for operative intervention. At 6\u2010month follow up, the reconstruction was stable with no tumor recurrence on clinical exam. Our results suggest that a supercharged pedicled DIEP flap may be a viable option for large defects of the thigh and can may be utilized in medically complex patients with poor capacity for wound healing.<\/jats:p>","DOI":"10.1002\/micr.31110","type":"journal-article","created":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T08:10:38Z","timestamp":1694247038000},"page":"831-836","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Supercharged deep inferior epigastric perforator flap for reconstruction of soft tissue defect after excision of giant invasive squamous cell carcinoma of the thigh in a refractory diabetic with <i>Pseudomonas aeruginosa<\/i> infection"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8633-4241","authenticated-orcid":false,"given":"Aldin","family":"Malkoc","sequence":"first","affiliation":[{"name":"Department of General Surgery Kaiser Permanente  Fontana California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark Jonathan","family":"Landau","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Kaiser Permanente  Fontana California USA"},{"name":"Department of Plastic Surgery Loma Linda University Medical Center  Loma Linda California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savannah","family":"Hodgkin","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Loma Linda University Medical Center  Loma Linda California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren Sze Mynn","family":"Leong","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Kaiser Permanente  Fontana California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir Dankha","family":"Johna","sequence":"additional","affiliation":[{"name":"Department of General Surgery Kaiser Permanente  Fontana California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter Ting\u2010Yu","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Kaiser Permanente  Fontana California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,9]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2020.38.15_suppl.10063"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001372"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30280"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19950115)75:2 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