{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T14:07:55Z","timestamp":1791986875626,"version":"4.4.0"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Lower extremity free flap failure rates are higher than in other areas of the body. While prior studies assessed the effect of intraoperative technical variables, these generally investigated individual variables and did not examine relationships between the many individual technical decisions made during free tissue reconstruction. Our purpose was to investigate the effect of variation in intraoperative microsurgical techniques on flap outcomes in a diverse cohort of patients requiring lower extremity free flap coverage.<\/jats:p><jats:p>\n          Methods\u2003Consecutive patients undergoing free flap reconstruction of the lower extremity at two level 1 trauma centers from January 2002 to January 2020 were identified using Current Procedural Terminology codes, followed by a review of medical records. Information regarding demographics and comorbidities, indications, intraoperative technical details, and complications was collected. Outcomes of interest included an unplanned return to the operating room, arterial thrombosis, venous thrombosis, partial flap failure, and total flap failure. Bivariate analysis was performed.<\/jats:p><jats:p>\n          Results\u2003In total, 410 patients underwent 420 free tissue transfers. The median follow-up time was 17 months (interquartile ranges: 8.0\u201337). Total flap failure occurred in 4.9% (n\u2009=\u200920), partial flap failure in 5.9% (n\u2009=\u200924), and unplanned reoperation in 9.0% (n\u2009=\u200937), with arterial thrombosis in 3.2% (n\u2009=\u200913) and venous thrombosis in 5.4% (n\u2009=\u200922). Overall complications were significantly associated with recipient artery choice, with arteries other than PT and AT\/DP having a higher rate (p\u2009=\u20090.033), and with arterial revisions (p\u2009=\u20090.010). Total flap failure was also associated with revision of the arterial anastomosis (p\u2009=\u20090.035), and partial flap failure was associated with recipient artery choice (p\u2009=\u20090.032).<\/jats:p><jats:p>\n          Conclusion\u2003Many interoperative options and techniques are available when performing microvascular lower extremity reconstruction that leads to equally high success rates. However, the use of arterial inflow outside of the posterior tibial and anterior tibial arteries leads to a higher overall complication rate and partial flap failure rate. Intraoperative revision of the arterial anastomosis portends poorly for ultimate flap survival.<\/jats:p>","DOI":"10.1055\/a-2071-3250","type":"journal-article","created":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T19:31:10Z","timestamp":1681241470000},"page":"078-086","source":"Crossref","is-referenced-by-count":10,"title":["Technical Variables in Lower Extremity Free Flap Reconstruction"],"prefix":"10.1055","volume":"40","author":[{"given":"Joani M.","family":"Christensen","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Ahn","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mara Z.","family":"Meulendijks","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Iskhakov","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frankie","family":"Wong","sequence":"additional","affiliation":[{"name":"Harvard Plastic Surgery Residency Training Program, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Winograd","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian L.","family":"Valerio","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Curtis L.","family":"Cetrulo","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia A.","family":"Helliwell","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle R.","family":"Eberlin","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,5,21]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/0007-1226(88)90141-5","article-title":"Analysis of 200 free flaps","volume":"41","author":"T Harashina","year":"1988","journal-title":"Br J Plast Surg"},{"issue":"08","key":"ref2","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1002\/micr.21807","article-title":"Vascular complication in free tissue transfer to the leg","volume":"21","author":"K Muramatsu","year":"2001","journal-title":"Microsurgery"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/01.GOX.0000799508.56659.aa","article-title":"Secondary surgery after lower extremity free tissue reconstruction","volume":"9","author":"F K Wong","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"08","key":"ref4","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1097\/00005373-198908000-00005","article-title":"Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases","volume":"29","author":"R K Khouri","year":"1989","journal-title":"J Trauma"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1097\/01.PRS.0000110328.47206.50","article-title":"A 10-year retrospective review of 758 DIEP flaps for breast reconstruction","volume":"113","author":"P S Gill","year":"2004","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"e2682","DOI":"10.1097\/GOX.0000000000002682","article-title":"Consecutive 265 profunda artery perforator flaps: refinements, satisfaction, and functional outcomes","volume":"8","author":"N T Haddock","year":"2020","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1055\/s-0040-1716846","article-title":"A meta-analysis of autologous microsurgical breast reconstruction and timing of adjuvant radiation therapy","volume":"37","author":"A J Heiman","year":"2021","journal-title":"J Reconstr Microsurg"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1097\/00006534-199909020-00011","article-title":"Influence of recipient vessels on free tissue transplantation of the extremities","volume":"104","author":"P Chaivanichsiri","year":"1999","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1007\/s11596-020-2235-8","article-title":"Use of muscle feeding arteries as recipient vessels for soft tissue reconstruction in lower extremities","volume":"40","author":"J Tian","year":"2020","journal-title":"Curr Med Sci"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"5341","DOI":"10.21037\/apm-21-827","article-title":"Repair of severe peri-knee soft tissue defect using an anterolateral thigh flap with the descending genicular vessels as the recipient pedicle: a case series of 14 patients","volume":"10","author":"J Liu","year":"2021","journal-title":"Ann Palliat Med"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1097\/SAP.0b013e31824e5e6e","article-title":"Recipient vessels in the free flap reconstruction around the knee","volume":"71","author":"T Fang","year":"2013","journal-title":"Ann Plast Surg"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1097\/SAP.0000000000002156","article-title":"The clinical application of medial sural vessels as recipient vessels in repairing traumatic tissue defects in the lower limbs","volume":"84","author":"J Fu","year":"2020","journal-title":"Ann Plast Surg"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1055\/s-0040-1708835","article-title":"Importance of vascularity and selecting the recipient vessels of lower extremity reconstruction","volume":"37","author":"J P Hong","year":"2021","journal-title":"J Reconstr Microsurg"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1055\/s-0037-1621746","article-title":"Proximal versus distal recipient vessels in lower extremity reconstruction: a retrospective series and systematic review","volume":"34","author":"J T Stranix","year":"2018","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1097\/PRS.0000000000008873","article-title":"Are perforators reliable as recipient arteries in lower extremity reconstruction? analysis of 423 free perforator flaps","volume":"149","author":"H A Power","year":"2022","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref16","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1097\/00000637-200044060-00009","article-title":"Both superficial and deep extremity veins can be used successfully as the recipient site for free flaps","volume":"44","author":"G G Hallock","year":"2000","journal-title":"Ann Plast Surg"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1016\/j.bjps.2010.07.028","article-title":"Selection of the recipient vein in microvascular flap reconstruction of the lower extremity: analysis of 362 free-tissue transfers","volume":"64","author":"A R Lorenzo","year":"2011","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1055\/s-0040-1702156","article-title":"Comparison of outcomes of end-to-end versus end-to-side anastomoses in lower extremity free flap reconstructions","volume":"36","author":"P N Broer","year":"2020","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref19","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1097\/PRS.0b013e3181cb636d","article-title":"1000 consecutive venous anastomoses using the microvascular anastomotic coupler in breast reconstruction","volume":"125","author":"S Jandali","year":"2010","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref20","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1055\/s-0035-1563737","article-title":"Venous thrombosis in handsewn versus coupled venous anastomoses in 857 consecutive breast free flaps","volume":"32","author":"A R Kulkarni","year":"2016","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1055\/s-0038-1660831","article-title":"Comparison of hand-sewn versus coupled venous anastomoses in traumatic lower extremity reconstruction","volume":"35","author":"J T Stranix","year":"2019","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1097\/SAP.0b013e31825c07a1","article-title":"Lower extremity free flap outcomes using an anastomotic venous coupler device","volume":"72","author":"N D Medina","year":"2014","journal-title":"Ann Plast Surg"},{"issue":"05","key":"ref23","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1002\/micr.20888","article-title":"Lower extremity free flap reconstruction outcomes using venous coupler","volume":"31","author":"I Ducic","year":"2011","journal-title":"Microsurgery"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s00405-017-4804-4","article-title":"Influence of coupler size on revision rate and timing of revision after free flap tissue transfer in the head and neck","volume":"275","author":"U Kisser","year":"2018","journal-title":"Eur Arch Otorhinolaryngol"},{"issue":"06","key":"ref25","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1097\/PRS.0000000000003865","article-title":"Smaller diameter anastomotic coupling devices have higher rates of venous thrombosis in microvascular free tissue transfer","volume":"140","author":"S E Hanson","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"08","key":"ref26","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1055\/s-0039-1688712","article-title":"Timing of free flaps for traumatic wounds of the lower extremity: have advances in perioperative care changed the treatment algorithm?","volume":"35","author":"C W Patterson","year":"2019","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1055\/s-0040-1717151","article-title":"When is the critical time for soft tissue reconstruction of open tibia fracture patients?","volume":"37","author":"S Y Lee","year":"2021","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.cps.2021.01.006","article-title":"The optimal timing of traumatic lower extremity reconstruction: current consensus","volume":"48","author":"Z H Lee","year":"2021","journal-title":"Clin Plast Surg"},{"issue":"07","key":"ref29","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1055\/s-0040-1710358","article-title":"Risk factors for lower extremity amputation following attempted free flap limb salvage","volume":"36","author":"W Piwnica-Worms","year":"2020","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1055\/s-0039-1696733","article-title":"Amputations versus salvage: reconciling the differences","volume":"37","author":"C K Black","year":"2021","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref31","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1055\/s-0039-1695753","article-title":"Principles of orthoplastic surgery for lower extremity reconstruction: why is this important?","volume":"37","author":"S C Azoury","year":"2021","journal-title":"J Reconstr Microsurg"},{"issue":"09","key":"ref32","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1055\/s-0041-1726398","article-title":"The need to improve patient-centered outcome reporting following lower extremity flap reconstruction: a systematic review and meta-analysis","volume":"37","author":"K G Kim","year":"2021","journal-title":"J Reconstr Microsurg"},{"issue":"09","key":"ref33","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1055\/s-0040-1713669","article-title":"Content validity of the LIMB-Q: a patient-reported outcome instrument for lower extremity trauma patients","volume":"36","author":"L R Mundy","year":"2020","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref34","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1055\/s-0039-3400515","article-title":"Long-term quality of life after free flap upper extremity reconstruction for traumatic injuries","volume":"36","author":"S van Bekkum","year":"2020","journal-title":"J Reconstr Microsurg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2071-3250.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T18:50:46Z","timestamp":1703616646000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2071-3250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,11]]},"references-count":34,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2023,12,26]]},"published-print":{"date-parts":[[2024,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2071-3250","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,4,11]]},"published":{"date-parts":[[2023,4,11]]}}}