{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:31:04Z","timestamp":1784248264939,"version":"3.55.0"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Free flap (FF) reconstruction is frequently required for soft-tissue coverage after significant orthopaedic trauma of the lower extremity (LE). While usually the final step in limb salvage, re-elevation of the previously inset FF may be necessary to restore a functional limb. In this study, we present our algorithm for LE FF re-elevation and review our experience to identify factors associated with successful limb salvage and return to ambulation.<\/jats:p><jats:p>\n          Methods\u2003A retrospective, single-institution review was conducted of adult patients with LE wounds who required FF reconstruction from 2016 to 2021. From this cohort, patients who required re-elevation of their LE FF were identified. Successful FF re-elevation was defined by limb salvage and return to ambulation.<\/jats:p><jats:p>\n          Results\u2003During the study period, 412 patients with LE wounds required flap reconstruction. Of these patients, 205 (49.8%) underwent free tissue transfer, and 39 (9.5%) met our inclusion criteria. From this cohort, 34 had successful FF re-elevation, while 1 was non\u2013weight bearing and 4 were elected for amputation due to chronic complications unrelated to their FF. Univariate analysis revealed the total number of FF re-elevations (p\u2009&lt;\u20090.001), the frequency of re-elevation indicated for orthopaedic access (p\u2009&lt;\u20090.001), and infections necessitating return to the operating room (p\u2009=\u20090.001) were each negatively associated with limb salvage and return to ambulation.<\/jats:p><jats:p>\n          Conclusion\u2003The described algorithm highlights the preoperative planning and meticulous flap preservation necessary for the successful coverage of critical structures following FF re-elevation. Our data demonstrate that LE FFs can be safely re-elevated for hardware access or flap revision. In these complex cases of LE trauma, management by a multidisciplinary team is essential for successful limb salvage.<\/jats:p>","DOI":"10.1055\/a-2404-2759","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T23:49:45Z","timestamp":1724802585000},"page":"415-423","source":"Crossref","is-referenced-by-count":2,"title":["Elevating Lower Extremity Reconstruction: An Algorithmic Approach to Free Flap Re-elevation"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2262-7325","authenticated-orcid":false,"given":"Jessica R.","family":"Nye","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Talanker","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Hopkins","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Memorial Hermann 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stay, and discharge to rehabilitation of traumatic amputee patients: an epidemiologic study","volume":"79","author":"T R Dillingham","year":"1998","journal-title":"Arch Phys Med Rehabil"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1002\/micr.30219","article-title":"Evaluation of 389 patients following free-flap lower extremity reconstruction with respect to secondary refinement procedures","volume":"38","author":"D Kotsougiani","year":"2018","journal-title":"Microsurgery"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1097\/01.GOX.0000547008.76955.05","article-title":"Abstract: Fasciocutaneous free flaps in extremity reconstruction: safety of re-elevation","volume":"6","author":"E Y Xue","year":"2018","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1097\/PRS.0b013e3182a80925","article-title":"Evidence-based medicine: lower extremity acute trauma","volume":"132","author":"G G Hallock","year":"2013","journal-title":"Plast Reconstr Surg"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/01.prs.0000305928.98611.87","article-title":"MOC-PS(SM) CME article: lower extremity reconstruction","volume":"121","author":"V Reddy","year":"2008","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1097\/PRS.0b013e3182046a16","article-title":"An evidence-based approach to lower extremity acute trauma","volume":"127","author":"N D Medina","year":"2011","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1097\/PRS.0b013e3181f95b67","article-title":"Secondary refinements of free perforator flaps for lower extremity reconstruction","volume":"127","author":"H G Hui-Chou","year":"2011","journal-title":"Plast Reconstr 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in comorbid patients","volume":"34","author":"K M Patel","year":"2014","journal-title":"Microsurgery"},{"issue":"05","key":"ref19","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1097\/PRS.0000000000010403","article-title":"Secondary surgery after lower extremity free flap reconstruction","volume":"152","author":"F K Wong","year":"2023","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1055\/s-0033-1343952","article-title":"A retrospective review of outcomes and flap selection in free tissue transfers for complex lower extremity reconstruction","volume":"29","author":"J P Fischer","year":"2013","journal-title":"J Reconstr Microsurg"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1002\/hed.20927","article-title":"Analysis of 49 cases of flap compromise in 1310 free flaps for head and neck reconstruction","volume":"31","author":"P Yu","year":"2009","journal-title":"Head Neck"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"e1228","DOI":"10.1097\/GOX.0000000000001228","article-title":"A comprehensive approach to lower extremity free-tissue transfer","volume":"5","author":"L LQ Pu","year":"2017","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"07","key":"ref23","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1002\/micr.30502","article-title":"Variables associated with 30-day postoperative complications in lower extremity free flap reconstruction identified in the ACS-NSQIP database","volume":"39","author":"J Veith","year":"2019","journal-title":"Microsurgery"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1097\/PRS.0000000000003927","article-title":"Muscle versus fasciocutaneous free flaps in lower extremity traumatic reconstruction: a multicenter outcomes analysis","volume":"141","author":"E H Cho","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref25","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":"03","key":"ref26","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/S0094-1298(20)30852-X","article-title":"Muscle flap coverage for the lower extremity","volume":"18","author":"G Guzman-Stein","year":"1991","journal-title":"Clin Plast Surg"},{"issue":"04","key":"ref27","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/S0094-1298(20)31541-8","article-title":"Acute management of severe soft-tissue damage accompanying open fractures of the lower extremity","volume":"13","author":"M J Yaremchuk","year":"1986","journal-title":"Clin Plast 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