{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T08:58:41Z","timestamp":1790585921374,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"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":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In distal lower\u2010limb reconstruction, reverse\u2010flow pedicled flaps remain vulnerable to venous congestion and partial flap loss, particularly after crush injury or major trauma, in elderly or comorbid patients and when longer flaps are required. We evaluated a standardized distally\u2010based pedicled posterior tibial artery perforator (PTAP)\u2010plus saphenous flap with planned supercharging and a temporary cutaneous bridge to reinforce venous outflow in that high\u2010risk subset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective study of 26 consecutive reconstructions (2010\u20132025) performed under a uniform protocol by the senior author was conducted. Inclusion criteria comprised patients at high risk for flap loss, defined by crush injury or major trauma; elderly or patients with relevant comorbidities; and longer flaps targeting distal reach. Preoperative Doppler identified the most distal reliable perforator as pivot. Supercharging was performed end\u2010to\u2010end between the saphenous system and a superficial vein near the defect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010six patients (21 men, 5 women; mean age, 34\u2009years; range, 18\u201361\u2009years) underwent reconstruction. Trauma accounted for 21 cases. Defects were located in the lower leg (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915), ankle (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20099), and foot (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092). Tibia or ankle joint was exposed in 18 cases and tendons in 8. Venous supercharging was performed using a GSV branch in 23 flaps and the LSV in 3. Mean flap size was 5\u2009\u00d7\u200916\u2009cm (width range, 4\u20137\u2009cm; length range, 7\u201320\u2009cm); mean distal perforator distance from the medial malleolus was 9\u2009cm (range, 5\u201312\u2009cm). The estimated mean arc of rotation was 100\u00b0 (range, 90\u00b0\u2013150\u00b0). Complete survival occurred in 24\/26 flaps (92.3%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A \u201ctripedicled,\u201d routinely supercharged PTA perforator plus saphenous flap, combined with a skin pedicle, provided reliable coverage of distal\u2010leg, ankle, and foot defects with a low rate of flap loss. Based on our data and experience, this configuration is feasible and safe for crush injuries, elderly\/comorbid patients, and longer flaps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>4.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70299","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:55:23Z","timestamp":1790070923000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Supercharged Pedicled\n                    <scp>PTAP<\/scp>\n                    \u2010Saphenous Flap for Distal Lower\u2010Limb Reconstruction"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0734-3551","authenticated-orcid":false,"given":"Stefano","family":"Bacchini","sequence":"first","affiliation":[{"name":"Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience University of Siena  Siena Italy"},{"name":"Department of Plastic and Reconstructive Surgery China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2993-8580","authenticated-orcid":false,"given":"Anna","family":"Scarabosio","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery China Medical University Hospital  Taichung Taiwan"},{"name":"Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME) Academic Hospital of Udine, University of Udine  Udine Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0899-8383","authenticated-orcid":false,"given":"Alessandro","family":"Mastroiacovo","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery China Medical University Hospital  Taichung Taiwan"},{"name":"Reconstructive Microsurgery Service, University Department of Hand Surgery and Rehabilitation San Giuseppe Hospital, IRCCS MultiMedica Group  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih\u2010Heng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Chang Gung Memorial Hospital, Chang Gung University and Medical College  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Bolletta","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery China Medical University Hospital  Taichung Taiwan"},{"name":"Plastic Surgery and Microsurgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Cigna","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery China Medical University Hospital  Taichung Taiwan"},{"name":"Plastic Surgery and Microsurgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2749-1909","authenticated-orcid":false,"given":"Hung\u2010Chi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2014.12.020"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001891"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000081071.83805.B6"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30162"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000258"},{"key":"e_1_2_12_7_1","first-page":"e16","article-title":"Super\u2010Drained Distally Based Neurofasciocutaneous Sural Flap: A Case Series and Review of Literature","volume":"15","author":"El\u2010Diwany 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