{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:45:35Z","timestamp":1787755535474,"version":"build-2784847793"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","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>A 20-year-old man sustained a Gustilo-Anderson type IIIB open tibial shaft fracture with Achilles tendon exposure after a motorcycle accident. Early flap surgery was not feasible because of coronavirus disease 2019 restrictions. The initial debridement, external fixation, and negative pressure wound therapy failed to generate sufficient granulation. Perifascial areolar tissue, a thin layer of loose connective tissue located between the deep fascia and the deep layer of subcutaneous fat, was harvested from the thigh and grafted onto the defect, thereby enabling successful full-thickness skin grafting. At 3 years, bone union had been achieved without infection or ankle motion limitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Perifascial areolar tissue may be an alternative when early flap coverage is not possible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.25.00626","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T19:00:31Z","timestamp":1769713231000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["An Exposed Achilles Tendon Reconstructed Using a Perifascial Areolar Tissue Graft From the Thigh in an Open Tibial Fracture"],"prefix":"10.2106","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7511-9526","authenticated-orcid":false,"given":"Koh","family":"Terauchi","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6092-3817","authenticated-orcid":false,"given":"Yoshimichi","family":"Onose","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8946-6349","authenticated-orcid":false,"given":"Naoki","family":"Haraguchi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,1]]},"reference":[{"issue":"5","key":"bib1-20260129","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1080\/02844310410029543","article-title":"Anatomical study of subcutaneous adipofascial tissue: a concept of the protective adipofascial system (PAFS) and lubricant adipofascial system (LAFS)","volume":"38","author":"Nakajima","year":"2004","journal-title":"Scand J Plast Reconstr Surg Hand Surg."},{"issue":"2","key":"bib2-20260129","doi-asserted-by":"crossref","first-page":"135","DOI":"10.4103\/0970-0358.73424","article-title":"Detail microscopic analysis of deep fascia of lower limb and its surgical implication","volume":"43","author":"Bhattacharya","year":"2010","journal-title":"Indian J Plast Surg."},{"issue":"suppl","key":"bib3-20260129","first-page":"A260","article-title":"Perifascial areolar application for coverage of exposed bone and tendon","volume":"73","author":"Kouraba","year":"2003","journal-title":"ANZ J Surg."},{"issue":"2","key":"bib4-20260129","doi-asserted-by":"crossref","first-page":"48","DOI":"10.36748\/ijswc.25-00003","article-title":"The perifascial areolar tissue: a review of the histologic characteristics and clinical applications of refractory wounds","volume":"6","author":"Abe","year":"2025","journal-title":"Int J Surg Wound Care."},{"issue":"12","key":"bib5-20260129","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1016\/j.bjps.2015.08.008","article-title":"The availability of perifascial areolar tissue graft for deep cutaneous ulcer coverage","volume":"68","author":"Hayashi","year":"2015","journal-title":"J Plast Reconstr Aesthet Surg."},{"issue":"11","key":"bib6-20260129","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1288\/00005537-197111000-00007","article-title":"Tympanoplasty: areolar tissue graft","volume":"81","author":"Goodman","year":"1971","journal-title":"Laryngoscope."},{"issue":"7","key":"bib9-20260129","doi-asserted-by":"crossref","first-page":"2460","DOI":"10.1097\/01.prs.0000219345.73727.f5","article-title":"Outcome of skin graft versus flap surgery in the salvage of the exposed achilles tendon in diabetics versus nondiabetics","volume":"117","author":"Attinger","year":"2006","journal-title":"Plast Reconstr Surg."},{"issue":"4","key":"bib10-20260129","doi-asserted-by":"crossref","first-page":"182e","DOI":"10.1097\/PRS.0b013e3181ea91e3","article-title":"Perifascial areolar tissue graft as a nonvascularized alternative to flaps","volume":"126","author":"Koizumi","year":"2010","journal-title":"Plast Reconstr Surg."},{"issue":"4","key":"bib11-20260129","doi-asserted-by":"crossref","first-page":"147","DOI":"10.36748\/ijswc.24-00009","article-title":"A case of open zone I extensor tendon rupture reconstructed by external oblique muscle aponeurosis with perifascial areolar tissue","volume":"5","author":"Hirayama","year":"2024","journal-title":"Int J Surg Wound Care."},{"issue":"1.2","key":"bib12-20260129","doi-asserted-by":"crossref","first-page":"96","DOI":"10.2152\/jmi.65.96","article-title":"The perifascial areolar tissue and negative pressure wound therapy for one-stage skin grafting on exposed bone and tendon","volume":"65","author":"Abe","year":"2018","journal-title":"J Med Invest."},{"issue":"1","key":"bib13-20260129","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1053\/j.jfas.2017.08.026","article-title":"A perifascial areolar tissue graft with topical administration of basic fibroblast growth factor for treatment of complex wounds with exposed tendons and\/or bones","volume":"57","author":"Miyanaga","year":"2018","journal-title":"J Foot Ankle Surg."},{"issue":"4","key":"bib14-20260129","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.jos.2017.04.005","article-title":"Responsiveness of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) in patients with hallux valgus","volume":"22","author":"Niki","year":"2017","journal-title":"J Orthop Sci."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.25.00626","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:40Z","timestamp":1787751880000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.25.00626"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.cc.25.00626","relation":{},"ISSN":["2160-3251"],"issn-type":[{"value":"2160-3251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}