{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:15:11Z","timestamp":1787004911928,"version":"build-2736575974"},"reference-count":39,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background\u2003Tendon rupture with extensive soft tissue loss has few reconstructive options. Composite free tissue transfers including skin and tendon offer an attractive reconstructive approach. Unfortunately, most studies discussing them come from sparse case reports. We systematically assess evidence supporting composite flap use in single-stage reconstruction of lower extremity tendon and soft tissue defects.<\/jats:p>\n                  <jats:p>Methods\u2003A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. OvidMEDLINEqueried for records pertaining to the study question using Medical Subject Heading (MeSH) terms such as \u201clower extremity,\u201d \u201ctendon,\u201d and \u201ccomposite flap.\u201d No limitations were placed on the year of publication, country of origin, or study size. Study characteristics and patient demographics were collected. Primary outcomes included:(1) defect location, composite flap characteristics;(2) return to ambulation;(3) joint range of motion;(4) patient satisfaction, and (5) complications.<\/jats:p>\n                  <jats:p>Results\u2003In total, 29 articles examining 173 patients with lower extremity tendon defects and soft tissue loss were identified. Average age was 44.3 years (SD 17.5); most patients were male (n\u2009=\u2009110, 66.3%). Achilles defect was mostly reported (n\u2009=\u2009151, 86.8%), followed by patellar (n\u2009=\u200917, 9.8%) and other tendon defects (n\u2009=\u20096, 3.4%). Average tendon defect size was 8.4\u2009cm (SD 4.0), average soft tissue loss was 80.2\u2009cm2 (SD 40.0). Most employed composite flap was anterolateral thigh and fascia lata (ALT\u2009+\u2009FL) (n\u2009=\u2009101, 58.0%). Most patients (n\u2009=\u2009134, 99.3%) returned to ambulation in an average 123.1 days (SD 78.3). Average reconstructive joint degree of motion was 62.1 degrees compared with normal degree of motion 62.3 degrees. Patient-reported outcomes demonstrated increased satisfaction after reconstruction.<\/jats:p>\n                  <jats:p>Conclusion\u2003Composite flaps effectively reconstruct a variety of tendon and soft tissue defects; the most reported flap is ALT\u2009+\u2009FL, which provides large flap territories and rapid healing in Achilles, patellar, and other tendon defects. In this review, patients with composite flaps demonstrated return to ambulation, minimal impairment in range of motion, and notable postoperative satisfaction.<\/jats:p>","DOI":"10.1055\/s-0042-1748977","type":"journal-article","created":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T18:59:51Z","timestamp":1656010791000},"page":"009-019","source":"Crossref","is-referenced-by-count":10,"title":["Composite Free Tissue Transfer for Reconstruction of Lower Extremity Tendon Injuries: A Systematic Review"],"prefix":"10.1055","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7998-5970","authenticated-orcid":false,"given":"Adaah A.","family":"Sayyed","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7517-4326","authenticated-orcid":false,"given":"Jenna C.","family":"Bekeny","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Day","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E.","family":"Attinger","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth L.","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen K.","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; 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Plastic and reconstructive surgery (1963)","volume":"143","author":"D Ehrl","year":"2019"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1302\/0301-620X.97B2.34521","article-title":"Reconstruction of defects involving the Achilles tendon and local soft tissues: a quick solution for a lingering problem","volume":"97-B","author":"J Soons","year":"2015","journal-title":"Bone Joint J"},{"issue":"07","key":"ref15","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1002\/micr.30420","article-title":"Quadriceps tendon reconstruction using a fascia lata included in a reverse-flow anterolateral thigh flap","volume":"39","author":"E Lucattelli","year":"2019","journal-title":"Microsurgery"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1002\/micr.30431","article-title":"Reconstruction of complex soft tissue defects including tendons with anterolateral thigh flap extended to fascia lata: long term recovery and functional outcomes","volume":"39","author":"P G di Summa","year":"2019","journal-title":"Microsurgery"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/00000637-199502000-00018","article-title":"Immediate tendon Achilles reconstruction with composite palmaris longus grafts","volume":"34","author":"J S Isenberg","year":"1995","journal-title":"Ann Plast Surg"},{"issue":"02","key":"ref18","first-page":"127","article-title":"A single-stage reconstruction of a complex Achilles wound with modified free composite lateral arm flap","volume":"24","author":"C Kim","year":"2008","journal-title":"J ReconstrMicrosurg"},{"issue":"06","key":"ref19","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1002\/micr.21972","article-title":"Multilayer reconstructions for defects overlying the Achilles tendon with the lateral-arm flap: long-term follow-up of 16 cases","volume":"32","author":"J M Smit","year":"2012","journal-title":"Microsurgery"},{"issue":"08","key":"ref20","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1002\/micr.22490","article-title":"The composite anterolateral thigh flap for Achilles tendon and soft tissue defect reconstruction with tendon repair by fascia with double or triple folding technique","volume":"35","author":"S K Youn","year":"2015","journal-title":"Microsurgery"},{"issue":"08","key":"ref21","first-page":"632","article-title":"Predictors of clinical outcome after reconstruction of complex soft tissue defects involving the Achilles tendon with the composite anterolateral thigh flap with vascularized fascia lata","volume":"34","author":"Z Jandali","year":"2018","journal-title":"J ReconstrMicrosurg"},{"issue":"07","key":"ref22","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1054\/bjps.2000.3407","article-title":"Reconstruction of the Achilles tendon and overlying soft tissue using antero-lateral thigh free flap","volume":"53","author":"J Lee","year":"2000","journal-title":"Br JPlastic Surg"},{"issue":"03","key":"ref23","first-page":"467","article-title":"ALT flap with vascularized fascia lata for one-stage functional patellar tendon reconstruction","volume":"72","author":"G Sapino","year":"2019","journal-title":"J Plastic, ReconstrAesthetic Surg"},{"issue":"04","key":"ref24","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1097\/01.sap.0000068080.76814.D7","article-title":"Reconstruction of combined defects of the Achilles tendon and the overlying soft tissue with a fascia lata graft and a free fasciocutaneous lateral arm flap","volume":"51","author":"F Haas","year":"2003","journal-title":"Ann Plast Surg"},{"issue":"03","key":"ref25","first-page":"205","article-title":"Reconstruction of the Achilles tendon and overlying soft tissue by free composite anterolateral thigh flap with vascularized fascia lata. Journal of reconstructive microsurgery","volume":"28","author":"P Houtmeyers","year":"2012"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/01.SAP.0000037270.95257.B9","article-title":"One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: clinical experience and functional assessment","volume":"50","author":"Y R Kuo","year":"2003","journal-title":"Ann Plast Surg"},{"issue":"01","key":"ref27","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1055\/s-0037-1608745","article-title":"Double-layer reconstruction of the Achilles' tendon using a modified Lindholm's technique and vascularized fascia lata","volume":"10","author":"O Kelahmetoglu","year":"2018","journal-title":"J Hand Microsurg"},{"issue":"02","key":"ref28","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.bjps.2005.07.011","article-title":"Functional reconstruction of Achilles tendon defects combined with overlaying skin defects using a free tensor fasciae latae flap","volume":"59","author":"J Dabernig","year":"2006","journal-title":"J Plastic, Reconstr Aesth Surg"},{"issue":"01","key":"ref29","first-page":"42","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 ReconstrMicrosurg"},{"issue":"02","key":"ref30","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/0007-1226(84)90002-X","article-title":"The free thigh flap: A new free flap concept based on the septocutaneous artery","volume":"37","author":"Y Song","year":"1984","journal-title":"Br J Plastic Surg"},{"issue":"06","key":"ref31","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/0007-1226(90)90199-A","article-title":"Reconstruction of Achilles tendon using vascularised fascia lata with free lateral thigh flap","volume":"43","author":"T Inoue","year":"1990","journal-title":"Br JPlastic Surg"},{"issue":"11","key":"ref32","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1007\/s00402-013-1833-3","article-title":"The composite anterolateral thigh flap for knee extensor and skin reconstruction","volume":"133","author":"S H Song","year":"2013","journal-title":"Arch Orthop Trauma Surg"},{"issue":"09","key":"ref33","first-page":"625","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 ReconstrMicrosurg"},{"issue":"02","key":"ref34","first-page":"195","article-title":"Reconstruction of knee joint soft tissue and patellar tendon defects using a composite anterolateral thigh flap with vascularized fascia lata","volume":"61","author":"Y Kuo","year":"2006","journal-title":"J Plastic, ReconstrAesth Surg"},{"issue":"03","key":"ref35","first-page":"225","article-title":"Reconstruction of foot and ankle defects with a free anterolateral thigh flap in pediatric patients","volume":"31","author":"M A Acar","year":"2015","journal-title":"J ReconstrMicrosurg"},{"issue":"04","key":"ref36","first-page":"309","article-title":"Functional reconstruction of acutely burnt Achilles tendon with composite anterolateral thigh flap with fascia lata: a case report","volume":"30","author":"V Andreu-Sola","year":"2017","journal-title":"Ann Burns Fire Disasters"},{"issue":"05","key":"ref37","first-page":"309","article-title":"Microsurgical reconstruction of the Achilles tendon with a fascia lata flap. Journal of reconstructive microsurgery","volume":"13","author":"J L Haddad","year":"1997"},{"issue":"10","key":"ref38","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1016\/j.injury.2015.06.046","article-title":"A free anterolateral thigh flap and iliotibial band for reconstruction of soft tissue defects at children's feet and ankles","volume":"46","author":"R Hu","year":"2015","journal-title":"Injury"},{"issue":"12","key":"ref39","first-page":"13","article-title":"Achilles tendon region defects: delayed composite anterolateral thigh flap with stripping of fascia lata: a case series","volume":"66","author":"C Tiengo","year":"2020","journal-title":"Wound ManagPrev"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0042-1748977.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,22]],"date-time":"2022-12-22T19:07:42Z","timestamp":1671736062000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0042-1748977"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,23]]},"references-count":39,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2022,12,22]]},"published-print":{"date-parts":[[2023,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0042-1748977","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,23]]}}}