{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T23:57:26Z","timestamp":1774483046720,"version":"3.50.1"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Indian J Plast Surg"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Composite defects due to trauma present with compound comminuted fractures with soft tissue loss. Stabilization requires multiple Schanz pins across the fracture segments and flap cover for soft tissue reconstruction. These pins hinder flap inset and may require complex planning with multiple flaps. A simple approach is to impale the flaps over these pins to achieve flap inset without disturbing the skeletal fixation. This method of impaling was utilized for free as well as pedicled fasciocutaneous and muscle flaps. A stab incision is made and careful dissection is done to create a passage for the pins without injuring the vascularity of these flaps. In this manner multiple pins can be passed as needed. Flap inset is then completed. Slight modifications in threading the pins are required depending on whether a free or a pedicled flap is used. This study includes 16 flaps of which 15 were for lower limbs and 1 was for upper limb reconstruction. Pedicled flaps used were 13, the most common being inferiorly based fasciocutaneous flaps. Free flaps used were three, which included two muscle flaps and one fasciocutaneous flap. Two flaps were impaled in three places. All the flaps survived without any loss. Suture line dehiscence in four flaps was managed conservatively. Impaling the flaps on Schanz pins is a simple procedure to achieve soft tissue reconstruction in compound defects. Knowledge of the vascular anatomy and blood supply of the flaps is imperative in protecting the pedicle and maintaining the vascularity.<\/jats:p>","DOI":"10.1055\/s-0045-1807284","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T23:39:43Z","timestamp":1761781183000},"page":"068-072","source":"Crossref","is-referenced-by-count":0,"title":["Flap Impaling: A Simple and Effective Technique in Soft Tissue Reconstruction of Complex Extremity Wounds"],"prefix":"10.1055","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8027-7058","authenticated-orcid":false,"given":"Sathish Kumar","family":"Jayaraman","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9925-8292","authenticated-orcid":false,"given":"Abiramie","family":"Chellamuthu","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srinivasan","family":"Venugopal","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vishnu Priya","family":"Vasudevan","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"issue":"S 05","key":"ref1","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1016\/j.injury.2019.10.045","article-title":"Selecting a free flap for soft tissue coverage in lower extremity reconstruction","volume":"50","author":"S D Kozusko","year":"2019","journal-title":"Injury"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1055\/s-0043-1778576","article-title":"Ipsilateral fasciocutaneous flaps for leg and foot defects","volume":"36","author":"V W Bhattacharya","year":"2003","journal-title":"Indian J Plast Surg"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"347","DOI":"10.52312\/jdrs.2024.1562","article-title":"Cross-leg flaps: a nonmicrosurgical alternative treatment method in complex lower extremity trauma reconstruction","volume":"35","author":"F I Can","year":"2024","journal-title":"Jt Dis Relat Surg"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1007\/s00068-018-1041-5","article-title":"External fixation of segmental tibial shaft fractures","volume":"46","author":"S Milenkovic","year":"2020","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"281","key":"ref5","first-page":"204","article-title":"The segmental tibial fracture","author":"T S Woll","year":"1992","journal-title":"Clin Orthop Relat Res"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s13018-014-0075-6","article-title":"A meta-analysis of external fixator versus intramedullary nails for open tibial fracture fixation","volume":"9","author":"X Xu","year":"2014","journal-title":"J Orthop Surg Res"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/0007-1226(82)90148-5","article-title":"Repair of lower leg injuries with fascio-cutaneous flaps","volume":"35","author":"T L Barclay","year":"1982","journal-title":"Br J Plast Surg"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s00276-014-1275-9","article-title":"The localization of the distal perforators of posterior tibial artery: a cadaveric study for the correct planning of medial adipofascial flaps","volume":"37","author":"A Bulla","year":"2015","journal-title":"Surg Radiol Anat"},{"issue":"07","key":"ref9","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1002\/ca.20847","article-title":"Cutaneous perforators of the peroneal artery: cadaveric study with implications in the design of the osteocutaneous free fibular flap","volume":"22","author":"D Papadimas","year":"2009","journal-title":"Clin Anat"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.injury.2013.09.003","article-title":"Distally based perforator flaps for reconstruction of post-traumatic defects of the lower leg and foot. A review of the anatomy and clinical outcomes","volume":"45","author":"N Tajsic","year":"2014","journal-title":"Injury"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1097\/PRS.0b013e3181b98a6c","article-title":"The perforasome theory: vascular anatomy and clinical implications","volume":"124","author":"M Saint-Cyr","year":"2009","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref12","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/0007-1226(86)90083-4","article-title":"The anatomy of the thoracodorsal artery within the latissimus dorsi muscle","volume":"39","author":"A R Rowsell","year":"1986","journal-title":"Br J Plast Surg"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/00006534-198401000-00001","article-title":"The vascular territories of the superior epigastric and the deep inferior epigastric systems","volume":"73","author":"J B Boyd","year":"1984","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/00006534-198108000-00012","article-title":"Tensor fascia lata myocutaneous free flaps","volume":"68","author":"H H Caffee","year":"1981","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref15","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/S0363-5023(78)80117-8","article-title":"Rectus femoris muscle and composite skin transplantation by microneurovascular anastomoses for avulsion of forearm muscles: a case report","volume":"3","author":"R R Schenck","year":"1978","journal-title":"J Hand Surg Am"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/S0363-5023(84)80181-1","article-title":"Functioning free muscle transplantation","volume":"9A","author":"R T Manktelow","year":"1984","journal-title":"J Hand Surg Am"}],"container-title":["Indian Journal of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0045-1807284.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T23:37:10Z","timestamp":1774481830000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0045-1807284"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,29]]},"references-count":16,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2026,3,25]]},"published-print":{"date-parts":[[2026,2]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0045-1807284","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0970-0358","1998-376X"],"issn-type":[{"value":"0970-0358","type":"print"},{"value":"1998-376X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,29]]}}}