{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:10:03Z","timestamp":1756379403484,"version":"3.44.0"},"reference-count":23,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,1,4]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>Many challenges have been described by microsurgeons in paediatric free flaps. With the advancement in microsurgical expertise, it is now possible to achieve excellent results. We present a case of a female child with car-tyre friction injury of bilateral feet with associated extradural haemorrhage who underwent emergency bilateral anterolateral thigh flap. A secondary tendon reconstruction of the left foot was performed at 6 months. No complications were observed in the postoperative period after both procedures and good functional recovery was achieved at 1 year follow-up. The problems unique to this case were the presence of head injury and bilateral extremity injury in the paediatric patient. The technical details of planning, execution, difficulties and recommendations to minimise the risk in such cases are discussed. To the best of our knowledge, this is the only case report of bilateral lower limb paediatric emergency free flap with associated head injury.<\/jats:p>","DOI":"10.1136\/bcr-2023-257181","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T02:06:48Z","timestamp":1706148408000},"page":"e257181","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Double microvascular free flap reconstruction for bilateral lower extremity injury in a paediatric patient"],"prefix":"10.1136","volume":"17","author":[{"given":"Shruthi","family":"Chandrasekar","sequence":"first","affiliation":[{"name":"Plastic Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5449-3398","authenticated-orcid":false,"given":"Raja","family":"Tiwari","sequence":"additional","affiliation":[{"name":"Plastic Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karthick","family":"Ganesan","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maneesh","family":"Singhal","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,1,24]]},"reference":[{"key":"2025082803282899000_17.1.e257181.1","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1097\/00000637-199606000-00002","article-title":"Aggressive use of free flaps in children for burn scar contractures and other soft-tissue deficits","volume":"36","author":"Mast","year":"1996","journal-title":"Annals of Plastic Surgery"},{"key":"2025082803282899000_17.1.e257181.2","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/01.SAP.0000044143.36516.32","article-title":"Free flap coverage of upper and lower limb tissue defects in children: a series of 22 patients","volume":"50","author":"Duteille","year":"2003","journal-title":"Ann Plast Surg"},{"key":"2025082803282899000_17.1.e257181.3","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000160698.68234.6C"},{"key":"2025082803282899000_17.1.e257181.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0305-4179(99)00130-8"},{"key":"2025082803282899000_17.1.e257181.5","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/S0749-0712(21)01361-5","article-title":"Reconstruction of congenital hand defects with microvascular toe transfers","volume":"1","author":"Gilbert","year":"1985","journal-title":"Hand Clin"},{"key":"2025082803282899000_17.1.e257181.6","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(91)90200-4"},{"key":"2025082803282899000_17.1.e257181.7","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/01241398-198909010-00016","article-title":"Free tissue transfer in children","volume":"9","author":"Shapiro","year":"1989","journal-title":"J Pediatr Orthop"},{"key":"2025082803282899000_17.1.e257181.8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1055\/s-2001-14506","article-title":"Elective free-tissue transfer in pediatric patients","volume":"17","author":"Y\u00fccel","year":"2001","journal-title":"J Reconstr Microsurg"},{"key":"2025082803282899000_17.1.e257181.9","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198806000-00003"},{"key":"2025082803282899000_17.1.e257181.10","doi-asserted-by":"publisher","DOI":"10.1097\/00001665-200307000-00031"},{"key":"2025082803282899000_17.1.e257181.11","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1002\/micr.20266","article-title":"Extremity salvage with a free musculocutaneous latissimus dorsi flap and free tendon transfer after resection of a large congenital fibro sarcoma in a 15-week-old infant: a case report","volume":"26","author":"Germann","year":"2006","journal-title":"Microsurgery"},{"key":"2025082803282899000_17.1.e257181.12","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.bjps.2003.10.009","article-title":"Microvascular reconstruction of a giant encephalocele defect in a 10-week-old infant","volume":"57","author":"Bayrami\u00e7li","year":"2004","journal-title":"Br J Plast Surg"},{"key":"2025082803282899000_17.1.e257181.13","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1097\/PRS.0b013e31816c3b81","article-title":"Pediatric free tissue transfer: a 29-year experience with 433 transfers","volume":"121","author":"Upton","year":"2008","journal-title":"Plast Reconstr Surg"},{"key":"2025082803282899000_17.1.e257181.14","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1002\/micr.1920120310","article-title":"Free tissue transfer for reconstruction of traumatic limb injuries in children","volume":"12","author":"Arnez","year":"1991","journal-title":"Microsurgery"},{"key":"2025082803282899000_17.1.e257181.15","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1055\/s-0034-1395888","article-title":"Reconstruction of foot and ankle defects with a free anterolateral thigh flap in pediatric patients","volume":"31","author":"Acar","year":"2015","journal-title":"J Reconstr Microsurg"},{"key":"2025082803282899000_17.1.e257181.16","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1002\/micr.22074","article-title":"Dorsal foot resurfacing using free anterolateral thigh (ALT) flap in children","volume":"33","author":"El-Gammal","year":"2013","journal-title":"Microsurgery"},{"key":"2025082803282899000_17.1.e257181.17","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1002\/micr.22021","article-title":"Subacute and delayed period microsurgical management of traumatic extremity injuries in pediatric population","volume":"32","author":"Arslan","year":"2012","journal-title":"Microsurgery"},{"key":"2025082803282899000_17.1.e257181.18","doi-asserted-by":"crossref","first-page":"47","DOI":"10.3113\/FAI.2010.0047","article-title":"Free anterolateral thigh flap for reconstruction of car tire injuries of children\u2019s feet","volume":"31","author":"Demirtas","year":"2010","journal-title":"Foot Ankle Int"},{"key":"2025082803282899000_17.1.e257181.19","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.ijscr.2017.06.066","article-title":"Sinan Bilginb immediate emergency free anterolateral thigh flap after car-tyre friction injury: a case report with eight years follow-up","volume":"38","author":"Merter","year":"2017","journal-title":"Int J Surg Case Rep"},{"key":"2025082803282899000_17.1.e257181.20","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1002\/micr.10128","article-title":"Emergency free flaps","volume":"23","author":"Georgescu","year":"2003","journal-title":"Microsurgery"},{"key":"2025082803282899000_17.1.e257181.21","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1055\/s-0038-1627445","article-title":"Operative time and flap failure in unilateral and bilateral free flap breast reconstruction","volume":"34","author":"Kwok","year":"2018","journal-title":"J Reconstr Microsurg"},{"key":"2025082803282899000_17.1.e257181.22","doi-asserted-by":"crossref","first-page":"e383","DOI":"10.1097\/BCR.0000000000000300","article-title":"Simultaneous extended ALT flaps for foot salvage after severe frostbite","volume":"37","author":"Fodor","year":"2016","journal-title":"J Burn Care Res"},{"key":"2025082803282899000_17.1.e257181.23","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/01.sap.0000120296.75440.ed","article-title":"Free adipofascial flap interposition for pediatric posttraumatic forearm synostosis with closed head injury","volume":"53","author":"Henry","year":"2004","journal-title":"Ann Plast Surg"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-257181","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:28:38Z","timestamp":1756376918000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-257181"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1,24]]},"published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1136\/bcr-2023-257181"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-257181","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,1]]}}}