{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T03:19:09Z","timestamp":1787541549784,"version":"build-2736575974"},"reference-count":17,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Free flap harvesting from paralyzed limbs represents a potentially valuable approach in reconstructive microsurgery, yet its safety and efficacy remain incompletely characterized. This systematic review evaluates the feasibility, safety, and outcomes of free flap harvesting from paralyzed limbs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive literature search was conducted across multiple databases for studies reporting free flap harvesting from paralyzed limbs. Studies were evaluated for flap type, etiology of paralysis, surgical outcomes, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine studies (16 patients) met inclusion criteria, published between 2006 and 2025. Post\u2010polio syndrome was the predominant etiology (15 patients, 93.8%), with one case of GNE myopathy. Anterolateral thigh flaps were most utilized (7 studies, 77.8%), followed by posterior tibial artery flaps (2 studies, 22.2%) and fibula flaps (1 study, 11.1%). All studies reported 100% flap success rates with no major complications. Minor complications included delayed wound healing (12.5%), infection (6.3%), and seroma formation (6.3%). Vascular anatomy remained intact despite long\u2010standing paralysis, with perforators and pedicles comparable to those in neurologically intact limbs. No patient experienced functional decline in the paralyzed donor limb postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Free flap harvesting from paralyzed limbs demonstrates excellent reliability with minimal donor site morbidity. This approach preserves functional tissue in unaffected limbs\u2014a critical consideration in patients with limited mobility. Despite muscle atrophy in paralyzed limbs, vascular integrity remains suitable for microsurgical transfer. For patients with paralysis requiring reconstruction, the paralyzed limb should be considered not merely an alternative but potentially a preferred donor site. Preoperative vascular assessment remains essential for optimal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70922","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T02:24:36Z","timestamp":1787538276000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Free Flap Harvesting From Paralyzed Limbs: A Systematic Review of Feasibility, Safety, and Functional Outcomes"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9590-9895","authenticated-orcid":false,"given":"Mohaned","family":"Mohamed","sequence":"first","affiliation":[{"name":"Plastic Surgery Department Northumbria NHS Trust  Newcastle UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1887-2811","authenticated-orcid":false,"given":"Mahmoud","family":"Farag","sequence":"additional","affiliation":[{"name":"Plastic Surgery Department Mersey and West Lancashire Teaching Hospitals NHS Trust  Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5430-5327","authenticated-orcid":false,"given":"Ahmed S.","family":"Youssef","sequence":"additional","affiliation":[{"name":"Trauma &amp; Orthopaedics Department Leeds Teaching Hospitals Trust  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Elrouby","sequence":"additional","affiliation":[{"name":"Trauma &amp; Orthopaedics Department Leeds Teaching Hospitals Trust  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2562-7291","authenticated-orcid":false,"given":"Amr","family":"Elbatawy","sequence":"additional","affiliation":[{"name":"Plastic Surgery Department Leeds Teaching Hospitals Trust  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"issue":"17","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm13175284","article-title":"Advances in Modern Microsurgery","volume":"13","author":"Thamm O. C.","year":"2024","journal-title":"Journal of Clinical Medicine"},{"issue":"3","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"174","DOI":"10.12790\/ahm.21.0097","article-title":"History and Recent Advances in Microsurgery","volume":"26","author":"Yoo H.","year":"2021","journal-title":"Archives of Hand and Microsurgery"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/15347346221090758"},{"issue":"7","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1179\/1743132811Y.0000000007","article-title":"Muscle, Tendons, and Bone: Structural Changes During Denervation and FES Treatment","volume":"33","author":"Gargiulo P.","year":"2011","journal-title":"Neurological Research"},{"issue":"2","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.21037\/cco-24-112","article-title":"Anterolateral Thigh Flap Harvested From Paralyzed Limbs in Post\u2010Polio Syndrome for Tongue Reconstruction\u2014A Case Report and a Review of the Literature","volume":"14","author":"Du W.","year":"2025","journal-title":"Chinese Clinical Oncology"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jormas.2025.102233","article-title":"Preparation of Anterolateral Thigh Flap From Polio\u2010Affected Lower Limb: A Safe Surgical Option That Preserves Patient's Motor Function","volume":"126","author":"Yuan Z. J.","year":"2025","journal-title":"Journal of Stomatology, Oral and Maxillofacial Surgery"},{"issue":"1","key":"e_1_2_9_8_1","doi-asserted-by":"crossref","DOI":"10.3390\/life15010036","article-title":"Assessing Donor Site Morbidity and Impact on Quality of Life in Free Flap Microsurgery: An Overview","volume":"15","author":"Hodea F. V.","year":"2024","journal-title":"Life"},{"issue":"1","key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"5e","DOI":"10.1097\/01.prs.0000221228.06175.cd","article-title":"Free Flaps Harvested From Paralytic Lower Extremities in Patients With Late Polio Sequel","volume":"118","author":"Ulusal B. G.","year":"2006","journal-title":"Plastic and Reconstructive Surgery"},{"issue":"2","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1097\/01.prs.0000197208.29709.83","article-title":"Posterior Tibial Artery Flap in Poliomyelitis Patients With Lower Extremity Paralysis","volume":"117","author":"Mardini S.","year":"2006","journal-title":"Plastic and Reconstructive Surgery"},{"issue":"6","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.bjps.2011.11.011","article-title":"Free\u2010Flap Harvesting From Paralytic Limbs of Poliomyelitis Patients\u2013A Safe and Feasible Option","volume":"65","author":"Chan R.","year":"2012","journal-title":"Journal of Plastic, Reconstructive & Aesthetic Surgery"},{"issue":"1","key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1016\/j.jcms.2011.01.005","article-title":"Anterolateral Thigh Flap Harvested From Paralytic Lower Extremity in a Patient With Late Polio Sequel","volume":"40","author":"Valentini V.","year":"2012","journal-title":"Journal of Cranio\u2010Maxillofacial Surgery"},{"issue":"1","key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1080\/23320885.2016.1200978","article-title":"Free Anterolateral Thigh Flap Harvesting From Paralytic Limbs in Post\u2010Polio Syndrome","volume":"3","author":"Changchien C. H.","year":"2016","journal-title":"Case Reports in Plastic Surgery and Hand Surgery"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s42399-020-00228-w","article-title":"Free Flap Harvesting From Paralytic Lower Limb in GNE Myopathy: A Case Report","volume":"2","author":"Oshima J.","year":"2020","journal-title":"SN Comprehensive Clinical Medicine"},{"issue":"8","key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1016\/j.ijom.2020.11.020","article-title":"Mandible Reconstruction Using a Vascularized Fibula Flap From a Post\u2010Polio Paralytic Limb","volume":"50","author":"Sakthipalan S. S.","year":"2021","journal-title":"International Journal of Oral and Maxillofacial Surgery"},{"issue":"1","key":"e_1_2_9_16_1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1038\/sc.2012.136","article-title":"Peripheral Vascular Function in Spinal Cord Injury: A Systematic Review","volume":"51","author":"West C. 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A.","year":"2005","journal-title":"Muscle & Nerve"},{"key":"e_1_2_9_18_1","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2022.1002310","article-title":"GNE Myopathy: History, Etiology, and Treatment Trials","volume":"13","author":"Mullen J.","year":"2022","journal-title":"Frontiers in Neurology"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70922","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ans.70922","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.70922","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T02:24:44Z","timestamp":1787538284000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.70922"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,23]]},"references-count":17,"alternative-id":["10.1111\/ans.70922"],"URL":"https:\/\/doi.org\/10.1111\/ans.70922","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"value":"1445-1433","type":"print"},{"value":"1445-2197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,23]]},"assertion":[{"value":"2025-06-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ans.70922"}}