{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T01:00:20Z","timestamp":1793149220924,"version":"4.5.0"},"reference-count":14,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T00:00:00Z","timestamp":1751673600000},"content-version":"vor","delay-in-days":4,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Reconstructing large knee defects after sarcoma resection poses a significant surgical challenge, particularly when vascular anatomy variations or intraoperative vessel damage limit conventional reconstructive options. Achieving stable, tension\u2010free coverage while preserving mobility is essential for optimal functional outcomes. We report the case of a 45\u2010year\u2010old male patient who underwent radical resection of a distal thigh myxofibrosarcoma, resulting in a large defect (24\u2009\u00d7\u200918\u2009cm) over the anterior knee region. A distally based anterolateral thigh (ALT) flap with two skin paddles was initially planned in order to achieve a \u201ckissing\u201d flap inset. However, intraoperative findings revealed that the distal part of the descending branch of the lateral circumflex femoral artery (DB\u2010LCFA) had been compromised, necessitating modifications to the reconstruction strategy. The distal ALT skin paddle was utilized as a pedicled propeller flap, while the proximal ALT skin paddle, which had a separate vascular supply, was harvested as a free flap and anastomosed to a distal perforator from the DB\u2010LCFA in a perforator\u2010to\u2010perforator fashion. Despite this approach, a significant residual defect remained. To achieve complete coverage, we performed an additional free flap using a vertical posterior medial thigh (vPMT) flap from the contralateral thigh, anastomosed to perforator vessels from the genicular artery. This case highlights the necessity of intraoperative adaptability when managing large oncologic defects, especially in the presence of vascular compromise. The combination of pedicled and free flaps, including an unconventional ALT flap configuration and a secondary vPMT flap, provided a stable, functional, and esthetically satisfactory outcome. Strategic integration of perforator\u2010based techniques and intraoperative imaging optimized flap viability, demonstrating a reliable approach for complex lower limb reconstructions.<\/jats:p>","DOI":"10.1002\/micr.70089","type":"journal-article","created":{"date-parts":[[2025,7,5]],"date-time":"2025-07-05T06:14:59Z","timestamp":1751696099000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Unconventional Combination of Thigh Flaps for Large Knee Defect Reconstruction After Sarcoma Resection: A Case Report"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4357-6985","authenticated-orcid":false,"given":"Matteo","family":"Meroni","sequence":"first","affiliation":[{"name":"Department of Hand\u2010 and Plastic Surgery Luzerner Kantonsspital  Lucerne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Martini","sequence":"additional","affiliation":[{"name":"Plastic Surgery Pyramide Haus Zur Pyramide  Zurich Switzerland"},{"name":"Department of Plastic Reconstructive and Aesthetic Surgery University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5289-9140","authenticated-orcid":false,"given":"Mario F.","family":"Scaglioni","sequence":"additional","affiliation":[{"name":"Department of Hand\u2010 and Plastic Surgery Luzerner Kantonsspital  Lucerne Switzerland"},{"name":"Plastic Surgery Pyramide Haus Zur Pyramide  Zurich Switzerland"},{"name":"Department of Health Sciences and Medicine University of Lucerne  Lucerne Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,5]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/BTK.0b013e3181a7eaec"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11751-018-0319-9"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31121"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31050"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.5312\/wjo.v5.i5.603"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000007643"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2021.01.009"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31081"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2024.07.047"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2020.12.002"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30044"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2020.12.025"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2022.06.100"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2022.04.008"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70089","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T07:04:06Z","timestamp":1753772646000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.70089"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":14,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1002\/micr.70089"],"URL":"https:\/\/doi.org\/10.1002\/micr.70089","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"2025-03-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70089"}}