{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T18:27:23Z","timestamp":1786991243692,"version":"build-2736575974"},"reference-count":9,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Simultaneous massive abdominal wall loss of domain (LOD) and chronic sacral pressure injury presents an exceptional reconstructive challenge. Optimal sequencing of reconstruction in patients with multifocal defects and impaired mobility remains poorly defined. In this case report, we describe a strategically staged approach prioritizing restoration of trunk stability to enable definitive pressure ulcer reconstruction in a complex patient. A 34\u2010year\u2010old male developed a 32\u2009\u00d7\u200925\u2009cm ventral abdominal wall defect with LOD and a persistent stage IV sacral ulcer following catastrophic complications of a gastric bypass. Severe abdominal LOD resulted in truncal flexion deformity and wheelchair dependence. Reconstruction was staged to prioritize abdominal wall restoration to improve mobility and allow effective pressure offloading before sacral reconstruction. AWR was performed using transversus abdominis release (TAR) with retromuscular mesh placement, partial fascial bridging, and a free anterolateral thigh (ALT) musculocutaneous flap to provide durable fascial reinforcement and soft\u2010tissue coverage. Restoration of abdominal domain significantly improved trunk stability and ambulation. Eight months later, the 14\u2009\u00d7\u200910\u2009cm sacral ulcer was definitively reconstructed using bilateral keystone perforator flaps. Both reconstructions healed without complication, resulting in marked functional recovery and elimination of wheelchair dependence. This case shows the effectiveness of a staged, multidisciplinary strategy for a patient with severe, multifocal soft\u2010tissue defects and supports the notion that a carefully staged and individualized reconstructive approach may provide durable restoration, substantially improving mobility, functional independence, and overall quality of life.<\/jats:p>","DOI":"10.1002\/micr.70256","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T07:25:41Z","timestamp":1781508341000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Staged Flap Reconstruction of Massive Abdominal Loss of Domain and Sacral Pressure Injury to Restore Quality of Life: A Case Report"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-1996-4474","authenticated-orcid":false,"given":"Kate","family":"Jensen","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic  Cleveland Ohio USA"},{"name":"University of South Carolina School of Medicine Greenville  Greenville South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7967-2210","authenticated-orcid":false,"given":"Diwakar","family":"Phuyal","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Ting","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffi","family":"Gurunian","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic  Abu Dhabi UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah N.","family":"Bishop","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10029\u2010019\u201001916\u2010w"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2017.01.018"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879\u2010018\u20103076\u2010y"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.69297"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000004404"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/burnst\/tkaa012"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.70059"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2012.01.012"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2017.02.018"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70256","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/micr.70256","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.70256","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T17:40:14Z","timestamp":1786988414000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.70256"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":9,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/micr.70256"],"URL":"https:\/\/doi.org\/10.1002\/micr.70256","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]},"assertion":[{"value":"2025-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70256"}}