{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T14:15:43Z","timestamp":1769782543079,"version":"3.49.0"},"reference-count":36,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The selection of recipient vessels is critical for the success of free flap transfer in lower extremity reconstruction following trauma. We hypothesized that variations in soft tissue, vascular, and bone injuries across different injury levels influence recipient vessel selection. This study aimed to investigate the injury patterns and recipient vessel selection at different injury levels.<\/jats:p>\n                  <jats:p>A retrospective analysis was performed on patients with acute open tibial fractures (Gustilo IIIB\/C) and mangled foot injuries treated at a single trauma center between 2013 and 2022. Injury levels were classified as proximal tibia (P\/3), middle tibia (M\/3), distal tibia (D\/3), and foot injuries. We analyzed injury patterns by level and defined recipient vessel selection as the primary outcome.<\/jats:p>\n                  <jats:p>A total of 91 limbs from 88 patients were analyzed (P\/3: 10, M\/3: 39, D\/3: 18, foot: 24). M\/3 injuries were the most severe, with extensive compartment involvement (p\u2009&lt;\u20090.01) and bone loss in 49% of cases, whereas P\/3 injuries were the least severe. The distal posterior tibial artery was predominantly used in P\/3 injuries, the proximal posterior tibial artery was most frequently used in M\/3 and D\/3 injuries, and the anterior tibial artery was used primarily for foot injuries (p\u2009&lt;\u20090.01). Vein grafts were required exclusively in M\/3 cases, with intraoperative vascular disturbances occurring in 33%. Postoperative vascular complications ranged from 6 to 20%, with an overall flap survival and limb salvage rate of 95%.<\/jats:p>\n                  <jats:p>Among the findings of this study, key findings were that M\/3 injuries were the most severe, and P\/3 injuries had favorable outcomes with distal posterior tibial artery anastomosis. Injury patterns and recipient vessel selection show distinct, level-specific differences in severe open fractures of the tibia and foot.<\/jats:p>","DOI":"10.1055\/a-2576-0389","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T18:56:27Z","timestamp":1748631387000},"page":"132-144","source":"Crossref","is-referenced-by-count":0,"title":["The Influence of the Level of Injury on the Selection of Recipient Vessels in Severe Open Fractures of the Tibia and Foot"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2543-7797","authenticated-orcid":false,"given":"Kota","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kentaro","family":"Futamura","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihiko","family":"Tsuchida","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Nishida","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayuki","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takafumi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanako","family":"Tsuihiji","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Sato","sequence":"additional","affiliation":[{"name":"Orthopedic Trauma Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/00006534-198609000-00001","article-title":"Early microsurgical reconstruction of complex trauma of the extremities","volume":"78","author":"M Godina","year":"1986","journal-title":"Plast Reconstr Surg"},{"issue":"07","key":"ref2","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1302\/0301-620X.82B7.0820959","article-title":"Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia","volume":"82","author":"S Gopal","year":"2000","journal-title":"J Bone Joint Surg Br"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1002\/micr.1920150514","article-title":"Selection of recipient vessels for free flaps to the distal leg and foot following trauma","volume":"15","author":"H C Chen","year":"1994","journal-title":"Microsurgery"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"1937","DOI":"10.1097\/00006534-199906000-00019","article-title":"Algorithm for recipient vessel selection in free tissue transfer to the lower extremity","volume":"103","author":"S Park","year":"1999","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1055\/s-0032-1306366","article-title":"Selection of recipient vessel in traumatic lower extremity","volume":"28","author":"S Yazar","year":"2012","journal-title":"J Reconstr Microsurg"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/S0094-1298(20)30655-6","article-title":"Refinements in lower extremity free flap surgery","volume":"17","author":"R D Acland","year":"1990","journal-title":"Clin Plast Surg"},{"issue":"10","key":"ref7","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1302\/0301-620X.88B10.17631","article-title":"A score for predicting salvage and outcome in Gustilo type-IIIA and type-IIIB open tibial fractures","volume":"88","author":"S Rajasekaran","year":"2006","journal-title":"J Bone Joint Surg Br"},{"issue":"S 05","key":"ref8","doi-asserted-by":"crossref","first-page":"S42","DOI":"10.1097\/BOT.0000000000000985","article-title":"Segmental bone loss reconstruction using ring fixation","volume":"31","author":"S M Quinnan","year":"2017","journal-title":"J Orthop Trauma"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1302\/0301-620X.89B1.17595","article-title":"Acute shortening and re-lengthening in the management of bone and soft-tissue loss in complicated fractures of the tibia","volume":"89","author":"M A El-Rosasy","year":"2007","journal-title":"J Bone Joint Surg Br"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1016\/j.jos.2021.09.018","article-title":"A Gustilo IIIB open tibial fracture complicated by a huge bone defect and larger soft tissue defect: a case report","volume":"28","author":"K Futamura","year":"2023","journal-title":"J Orthop 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zone of injury in lower extremity trauma","volume":"99","author":"A R Kolker","year":"1997","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref21","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":"05","key":"ref22","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1097\/00006534-199404001-00017","article-title":"Reconstruction of the traumatized leg: use of distally based free flaps","volume":"93","author":"B E Stompro","year":"1994","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref23","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1097\/PRS.0000000000005552","article-title":"Comparing reconstructive outcomes in patients with gustilo type IIIB fractures and concomitant arterial injuries","volume":"143","author":"J A Ricci","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"08","key":"ref24","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":"05","key":"ref25","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1097\/01.TA.0000114637.29779.AB","article-title":"Sixty-five clinical cases of free tissue transfer using long arteriovenous fistulas or vein grafts","volume":"56","author":"C H Lin","year":"2004","journal-title":"J Trauma"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1055\/a-2181-7149","article-title":"Implications of single-vessel runoff on long-term outcomes of free tissue transfer for lower extremity 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Res"},{"issue":"07","key":"ref33","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1002\/micr.30271","article-title":"Optimizing venous outflow in reconstruction of Gustilo IIIB lower extremity traumas with soft tissue free flap coverage: Are two veins better than one?","volume":"38","author":"J T Stranix","year":"2018","journal-title":"Microsurgery"},{"issue":"06","key":"ref34","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1097\/PRS.0000000000001791","article-title":"A systematic review and meta-analysis of double venous anastomosis in free flaps","volume":"136","author":"S Riot","year":"2015","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref35","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1055\/s-0034-1372368","article-title":"One versus two venous anastomoses in microsurgical free flaps: a meta-analysis","volume":"30","author":"I Ahmadi","year":"2014","journal-title":"J Reconstr 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