{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:50:46Z","timestamp":1787755846041,"version":"build-2784847793"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","funder":[{"DOI":"10.13039\/100005713","name":"Office of the Secretary of Defense","doi-asserted-by":"crossref","award":["W81XWH 19 1 0487"],"award-info":[{"award-number":["W81XWH 19 1 0487"]}],"id":[{"id":"10.13039\/100005713","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>We present a 42-year-old man who developed extensive left lower extremity arterial thrombosis following COVID-19 pneumonia. Despite multiple revascularization attempts and a below-knee amputation, he faced wound necrosis and insufficient soft tissue coverage. An innovative approach using a pedicled flap and sequential flow-through free flaps was used for limb salvage. Further interventions included through-knee amputation and targeted muscle reinnervation vs. nerve capping to address phantom limb pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This case demonstrates the potential of sequential flow-through free flaps in complex limb salvage when traditional revascularization is unfeasible, emphasizing early intervention and vigilant complication management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.24.00427","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T14:00:37Z","timestamp":1738245637000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Complex Lower Extremity Salvage Using Composite Flap Grafting in COVID-19\u2013Induced Arterial Thrombosis"],"prefix":"10.2106","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3452-2988","authenticated-orcid":false,"given":"Neil","family":"Jain","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Texas Tech University Health Sciences, Center; Lubbock, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3946-7247","authenticated-orcid":false,"given":"Caroline J.","family":"Cushman","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Texas Tech University Health Sciences, Center; Lubbock, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9587-2093","authenticated-orcid":false,"given":"Evan J.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Texas Tech University Health Sciences, Center; Lubbock, Texas"},{"name":"Department of Health Sciences, College of Health Sciences, Rush University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4649-6147","authenticated-orcid":false,"given":"Nicholas T.","family":"Haddock","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7538-2857","authenticated-orcid":false,"given":"Brendan J.","family":"MacKay","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Texas Tech University Health Sciences, Center; Lubbock, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,1]]},"reference":[{"key":"bib1-20250130","doi-asserted-by":"crossref","first-page":"108427","DOI":"10.1016\/j.clim.2020.108427","article-title":"COVID-19 pathophysiology: a review","volume":"215","author":"Yuki","year":"2020","journal-title":"Clin Immunol."},{"key":"bib2-20250130","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.avsg.2020.08.087","article-title":"Arterial thrombosis in coronavirus disease 2019 patients: a rapid systematic review","volume":"70","author":"Cheruiyot","year":"2021","journal-title":"Ann Vasc Surg."},{"issue":"3","key":"bib3-20250130","first-page":"e7355","article-title":"Coronavirus (COVID-19): a review of clinical features, diagnosis, and treatment","volume":"12","author":"Hassan","year":"2020","journal-title":"Cureus."},{"key":"bib4-20250130","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.cca.2020.04.027","article-title":"Hyperinflammation and derangement of renin-angiotensin-aldosterone system in COVID-19: a novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis","volume":"507","author":"Henry","year":"2020","journal-title":"Clinica Chim Acta Int J Clin Chem."},{"key":"bib5-20250130","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.avsg.2021.03.003","article-title":"Acute limb ischemia in hospitalized COVID-19 patients","volume":"74","author":"Topcu","year":"2021","journal-title":"Ann Vasc Surg."},{"key":"bib6-20250130","first-page":"102537","article-title":"Interleukin-6 Use in COVID-19 pneumonia related macrophage activation syndrome","author":"Sharif","year":"2020","journal-title":"Autoimmun Rev."},{"issue":"10229","key":"bib7-20250130","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/S0140-6736(20)30628-0","article-title":"COVID-19: consider cytokine storm syndromes and immunosuppression","volume":"395","author":"Mehta","year":"2020","journal-title":"Lancet."},{"issue":"2","key":"bib8-20250130","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.ejvs.2019.09.006","article-title":"Editor's choice\u2014European society for vascular surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia","volume":"59","author":"Bj\u00f6rck","year":"2020","journal-title":"Eur J Vasc endovascular Surg."},{"key":"bib9-20250130","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.avsg.2020.05.031","article-title":"COVID-19-related aortic thrombosis: a report of four cases","volume":"67","author":"Gomez-Arbelaez","year":"2020","journal-title":"Ann Vasc Surg."},{"issue":"6","key":"bib10-20250130","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1002\/micr.20268","article-title":"Flow-through flaps: a review of current knowledge and a novel classification system","volume":"26","author":"Bullocks","year":"2006","journal-title":"Microsurgery."},{"issue":"3","key":"bib11-20250130","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1055\/s-2005-869822","article-title":"Flow-through, functioning, free musculocutaneous flap transfer for restoration of a mangled extremity","volume":"21","author":"Ozkan","year":"2005","journal-title":"J Reconstr Microsurg."},{"key":"bib12-20250130","first-page":"4","article-title":"The \u2018Orochi\u2019 flap concept: multi-stage combined flap using sequential flaps","volume":"3","author":"Koshima","year":"2018","journal-title":"Int J Microsurgery."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.24.00427","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:50:49Z","timestamp":1787752249000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.24.00427"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.cc.24.00427","relation":{},"ISSN":["2160-3251"],"issn-type":[{"value":"2160-3251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}