Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma

Matthew R Zeiderman; MD; Lee L Q Pu; MD; PhD

doi:10.1093/burnst/tkab024

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Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma

更新时间：2022-06-14

- Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma
- Burns & Trauma Vol. 9, Issue 1, (2021)
- 作者机构：
  
  Division of Plastic & Reconstructive Surgery
- 作者简介：
- 基金信息：
- DOI：10.1093/burnst/tkab024
  CLC：
- Published：2021，
  
  Published Online：30 July 2021，
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Matthew R Zeiderman, MD, Lee L Q Pu, MD, PhD, Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma, Burns & Trauma, Volume 9, 2021, tkab024, https://doi.org/10.1093/burnst/tkab024
DOI：

Matthew R Zeiderman, MD, Lee L Q Pu, MD, PhD, Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma, Burns & Trauma, Volume 9, 2021, tkab024, https://doi.org/10.1093/burnst/tkab024 DOI：

摘要

Abstract

The complex lower extremity wound is frequently encountered by orthopedic and plastic surgeons. Innovations in wound care

soft tissue coverage and surgical fixation techniques allow for improved functional outcomes in this patient population with highly morbid injuries. In this review

the principles of reconstruction of complex lower extremity traumatic wounds are outlined. These principles include appropriate initial evaluation of the patient and mangled extremity

as well as appropriate patient selection for limb salvage. The authors emphasize proper planning for reconstruction

timing of reconstruction and the importance of an understanding of the most appropriate reconstructive option. The role of different reconstructive and wound care modalities is discussed

notably negative pressure wound therapy and dermal substitutes. The role of pedicled flaps and microvascular free-tissue transfer are discussed

as are innovations in understanding of perforator anatomy and perforator flap surgery that have broadened the reconstruction surgeon’s armamentarium. Finally

the importance of a multidisciplinary team is highlighted via the principle of the orthoplastic approach to management of complex lower extremity wounds. Upon completion of this review

the reader should have a thorough understanding of the principles of contemporary lower extremity reconstruction.

关键词

Keywords

Lower extremitySoft tissueReconstructionTraumaSurgical approach

references

Janis JE, O'Reilly E. Lower Extremity Reconstruction. St. Louis, MO:Quality Medical Publishing, 2014.

Janis JE, Kwon RK, Attinger CE. The new reconstructive ladder: modifications to the traditional model. Plast Reconstr Surg. 2011;127:205s–12.

Pu LLQ, Stevenson TR. Principles of reconstruction for complex lower extremity wounds. Techniques in Orthopaedics. 2009;24:78–87.

Parrett BM, Matros E, Pribaz JJ, Orgill DP. Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures. Plast Reconstr Surg. 2006;117:1315–22 discussion 1323-1314.

Pu LL. A comprehensive approach to lower extremity free-tissue transfer. Plast Reconstr Surg Glob Open. 2017;5:e1228.

Soto JA, Múnera F, Morales C, Lopera JE, Holguín D, Guarín O, et al. Focal arterial injuries of the proximal extremities: helical CT arteriography as the initial method of diagnosis. Radiology. 2001;218:188–94.

Hiatt MD, Fleischmann D, Hellinger JC, Rubin GD. Angiographic imaging of the lower extremities with multidetector CT. Radiol Clin North Am. 2005;43:1119–27 ix.

Saddawi-Konefka D, Kim HM, Chung KC. A systematic review of outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia. Plast Reconstr Surg. 2008;122:1796–805.

Bosse MJ, Mac Kenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002;347:1924–31.

Mac Kenzie EJ, Bosse MJ, Kellam JF, Pollak AN, Webb LX, Swiontkowski MF, et al. Early predictors of long-term work disability after major limb trauma. J Trauma. 2006;61:688–94.

Akula M, Gella S, Shaw CJ, McShane P, Mohsen AM. A meta-analysis of amputation versus limb salvage in mangled lower limb injuries--the patient perspective. Injury. 2011;42:1194–7.

Melcer T, Sechriest VF, Walker J, Galarneau M. A comparison of health outcomes for combat amputee and limb salvage patients injured in Iraq and Afghanistan wars. J Trauma Acute Care Surg. 2013;75:S247–54.

Doukas WC, Hayda RA, Frisch HM, Andersen RC, Mazurek MT, Ficke JR, et al. The military extremity trauma amputation/limb salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma. J Bone Joint Surg Am. 2013;95:138–45.

van Dongen TT, Huizinga EP, de Kruijff LG, van der Krans AC, Hoogendoorn JM, Leenen LP, et al. Amputation: not a failure for severe lower extremity combat injury. Injury. 2017;48:371–7.

Chung KC, Saddawi-Konefka D, Haase SC, Kaul G. A. Cost-utility analysis of amputation versus salvage for Gustilo type IIIB and IIIC open tibial fractures. Plast Reconstr Surg. 2009;124:1965–73.

MacKenzie EJ, Jones AS, Bosse MJ, Castillo RC, Pollak AN, Webb LX, et al. Health-care costs associated with amputation or reconstruction of a limb-threatening injury. J Bone Joint Surg Am. 2007;89:1685–92.

Higgins TF, Klatt JB, Beals TC. Lower extremity assessment project (LEAP)--the best available evidence on limb-threatening lower extremity trauma. Orthop Clin North Am. 2010;41:233–9.

Bosse MJ, McCarthy ML, Jones AL, Webb LX, Sims SH, Sanders RW, et al. The insensate foot following severe lower extremity trauma: an indication for amputation? J Bone Joint Surg Am. 2005;87:2601–8.

Lange RH, Bach AW, Hansen ST, Jr, Johansen KH. Open tibial fractures with associated vascular injuries: prognosis for limb salvage. J Trauma. 1985;25:203–8.

Heller L, Levin LS. Lower extremity microsurgical reconstruction. Plast Reconstr Surg. 2001;108:1029–41 quiz 1042.

Khouri RK. Avoiding free flap failure. Clin Plast Surg. 1992;19:773–81.

Attinger CE, Janis JE, Steinberg J, Schwartz J, Al-Attar A, Couch K. Clinical approach to wounds: débridement and wound bed preparation including the use of dressings and wound-healing adjuvants. Plast Reconstr Surg. 2006;117:72s–109.

Anghel EL, DeFazio MV, Barker JC, Janis JE, Attinger CE. Current concepts in debridement: science and strategies. Plast Reconstr Surg. 2016;138:82s–93.

Yaremchuk MJ, Brumback RJ, Manson PN, Burgess AR, Poka A, Weiland AJ. Acute and definitive management of traumatic osteocutaneous defects of the lower extremity. Plast Reconstr Surg. 1987;80:1–14.

Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. 1986;78:285–92.

Byrd HS, Cierny G 3rd, Tebbetts JB. The management of open tibial fractures with associated soft-tissue loss: external pin fixation with early flap coverage. Plast Reconstr Surg. 1981;68:73–82.

Hill JB, Vogel JE, Sexton KW, Guillamondegui OD, Corral GA, Shack RB. Re-evaluating the paradigm of early free flap coverage in lower extremity trauma. Microsurgery. 2013;33:9–13.

Starnes-Roubaud MJ, Peric M, Chowdry F, Nguyen JT, Schooler W, Sherman R, et al. Microsurgical lower extremity reconstruction in the subacute period: a safe alternative. Plast Reconstr Surg Glob Open. 2015;3:e449.

Karanas YL, Nigriny J, Chang J. The timing of microsurgical reconstruction in lower extremity trauma. Microsurgery. 2008;28:632–4.

Lee Z-H, Stranix JT, Rifkin WJ, Daar DA, Anzai L, Ceradini DJ, et al. Timing of microsurgical reconstruction in lower extremity trauma: an update of the Godina paradigm. Plast Reconstr Surg. 2019;144:759–67.

Colen DL, Colen LB, Levin LS, Kovach SJ. Godina's principles in the twenty-first century and the evolution of lower extremity trauma reconstruction. J Reconstr Microsurg. 2018;34:563–71.

Sheckter CC, Pridgen B, Li A, Curtin C, Momeni A. Regional variation and trends in the timing of lower extremity reconstruction: a 10-year review of the Nationwide inpatient sample. Plast Reconstr Surg. 2018;142:1337–47.

Steiert AE, Gohritz A, Schreiber TC, Krettek C, Vogt PM. Delayed flap coverage of open extremity fractures after previous vacuum-assisted closure (VAC) therapy - worse or worth? J Plast Reconstr Aesthet Surg. 2009;62:675–83.

Schlatterer DR, Hirschfeld AG, Webb LX. Negative pressure wound therapy in grade IIIB tibial fractures: fewer infections and fewer flap procedures? Clin Orthop Relat Res. 2015;473:1802–11.

Liu X, Zhang H, Cen S, Huang F. Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures: a systematic review and meta-analysis. Int J Surg. 2018;53:72–9.

Rinker B, Amspacher JC, Wilson PC, Vasconez HC. Subatmospheric pressure dressing as a bridge to free tissue transfer in the treatment of open tibia fractures. Plast Reconstr Surg. 2008;121:1664–73.

Patterson CW, Stalder MW, Richardson W, Steele T, Wise MW, St Hilaire H. Timing of free flaps for traumatic wounds of the lower extremity: have advances in perioperative care changed the treatment algorithm? J Reconstr Microsurg. 2019;35:616–21.

Francel TJ, Vander Kolk CA, Hoopes JE, Manson PN, Yaremchuk MJ. Microvascular soft-tissue transplantation for reconstruction of acute open tibial fractures: timing of coverage and long-term functional results. Plast Reconstr Surg. 1992;89:478–87 discussion 488-479.

Khouri RK, Shaw WW. Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases. J Trauma. 1989;29:1086–94.

Kolker AR, Kasabian AK, Karp NS, Gottlieb JJ. Fate of free flap microanastomosis distal to the zone of injury in lower extremity trauma. Plast Reconstr Surg. 1997;99:1068–73.

Hertel R, Lambert SM, Müller S, Ballmer FT, Ganz R. On the timing of soft-tissue reconstruction for open fractures of the lower leg. Arch Orthop Trauma Surg. 1999;119:7–12.

Gopal S, Majumder S, Batchelor AG, Knight SL, De Boer P, Smith RM. Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia. J Bone Joint Surg Br. 2000;82:959–66.

Liu DS, Sofiadellis F, Ashton M, MacGill K, Webb A. Early soft tissue coverage and negative pressure wound therapy optimises patient outcomes in lower limb trauma. Injury. 2012;43:772–8.

Chaput B, Meresse T, Bekara F, Grolleau JL, Gangloff D, Gandolfi S, et al. Lower limb perforator flaps: current concept. Ann Chir Plast Esthet. 2020;65:496–516.

Mohan AT, Sur YJ, Zhu L, Morsy M, Wu PS, Moran SL, et al. The concepts of propeller, perforator, keystone, and other local flaps and their role in the evolution of reconstruction. Plast Reconstr Surg. 2016;138:710e–29.

Cho EH, Shammas RL, Carney MJ, Weissler JM, Bauder AR, Glener AD, et al. Muscle versus Fasciocutaneous free flaps in lower extremity traumatic reconstruction: a Multicenter outcomes analysis. Plast Reconstr Surg. 2018;141:191–9.

Bigdeli AK, Gazyakan E, Schmidt VJ, Bauer C, Germann G, Radu CA, et al. Long-term outcome after successful lower extremity free flap salvage. J Reconstr Microsurg. 2019;35:263–9.

Wettstein R, Schürch R, Banic A, Erni D, Harder Y. Review of 197 consecutive free flap reconstructions in the lower extremity. J Plast Reconstr Aesthet Surg. 2008;61:772–6.

Sofiadellis F, Liu DS, Webb A, Macgill K, Rozen WM, Ashton MW. Fasciocutaneous free flaps are more reliable than muscle free flaps in lower limb trauma reconstruction: experience in a single trauma center. J Reconstr Microsurg. 2012;28:333–40.

Schmidt VJ, Kneser U. Pedicled flaps in the reconstruction of complex wounds at the lower extremity. Z Orthop Unfall. 2019;157:95–108.

Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38:563–76 discussion 577.

Webb LX. New techniques in wound management: vacuum-assisted wound closure. J Am Acad Orthop Surg. 2002;10:303–11.

DeFranzo AJ, Argenta LC, Marks MW, Molnar JA, David LR, Webb LX, et al. The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds with exposed bone. Plast Reconstr Surg. 2001;108:1184–91.

Raju A, Ooi A, Ong YS, Tan BK. Traumatic lower limb injury and microsurgical free flap reconstruction with the use of negative pressure wound therapy: is timing crucial? J Reconstr Microsurg. 2014;30:427–30.

Bhattacharyya T, Mehta P, Smith M, Pomahac B. Routine use of wound vacuum-assisted closure does not allow coverage delay for open tibia fractures. Plast Reconstr Surg. 2008;121:1263–6.

Hou Z, Irgit K, Strohecker KA, Matzko ME, Wingert NC, DeSantis JG, et al. Delayed flap reconstruction with vacuum-assisted closure management of the open IIIB tibial fracture. J Trauma. 2011;71:1705–8.

Shakir S, Messa CA, Broach RB, Rhemtulla IA, Chatman B, D'Angelantonio A, et al. Indications and limitations of bilayer wound matrix-based lower extremity reconstruction: a multidisciplinary case-control study of 191 wounds. Plast Reconstr Surg. 2020;145:813–22.

Pu LLQ. An alternative approach for soft-tissue coverage of a complex wound in the foot and ankle with vacuum-assisted closure over artificial dermis and subsequent skin graft. J Plast Reconstr Aesthet Surg. 2009;62:e682–4.

Molnar JA, DeFranzo AJ, Hadaegh A, Morykwas MJ, Shen P, Argenta LC. Acceleration of Integra incorporation in complex tissue defects with subatmospheric pressure. Plast Reconstr Surg. 2004;113:1339–46.

Kim PJ, Attinger CE, Steinberg JS, Evans KK. Integra® bilayer wound matrix application for complex lower extremity soft tissue reconstruction. Surg Technol Int. 2014;24:65–73.

Shores JT, Hiersche M, Gabriel A, Gupta S. Tendon coverage using an artificial skin substitute. J Plast Reconstr Aesthet Surg. 2012;65:1544–50.

Lou X, Xue H, Li G, Wang K, Zhou P, Li B, et al. One-stage Pelnac reconstruction in full-thickness skin defects with bone or tendon exposure. Plast Reconstr Surg Glob Open. 2018;6:e1709.

Pu LL. Soft-tissue reconstruction of an open tibial wound in the distal third of the leg: a new treatment algorithm. Ann Plast Surg. 2007;58:78–83.

Song P, Pu LLQ. The soleus muscle flap: an overview of its clinical applications for lower extremity reconstruction. Ann Plast Surg. 2018;81:S109–s116.

Tobin GR. Hemisoleus and reversed hemisoleus flaps. Plast Reconstr Surg. 1985;76:87–96.

Pu LL. The reversed medial hemisoleus muscle flap and its role in reconstruction of an open tibial wound in the lower third of the leg. Ann Plast Surg. 2006;56:59–63 discussion 63-54.

Pu LL. Soft-tissue coverage of an extensive mid-tibial wound with the combined medial gastrocnemius and medial hemisoleus muscle flaps: the role of local muscle flaps revisited. J Plast Reconstr Aesthet Surg. 2010;63:e605–10.

Thornton BP, Pu LLQ. Reconstruction of an extensive tibial soft-tissue defect with multiple local muscle flaps for limb salvage when free-tissue transfer was not an option. Eur J Plast Surg. 2004;27:217–21.

Ebraheim NA, Madsen TD, Humpherys B. The tibialis anterior used as a local muscle flap over the tibia after soft tissue loss. J Trauma Acute Care Surg. 2003;55:959–61.

Hollier L, Sharma S, Babigumira E, Klebuc M. Versatility of the sural fasciocutaneous flap in the coverage of lower extremity wounds. Plast Reconstr Surg. 2002;110:1673–9.

Follmar KE, Baccarani A, Baumeister SP, Levin LS, Erdmann D. The distally based sural flap. Plast Reconstr Surg. 2007;119:138e–48.

Jeng SF, Wei FC. Distally based sural island flap for foot and ankle reconstruction. Plast Reconstr Surg. 1997;99:744–50.

Sugg KB, Schaub TA, Concannon MJ, Cederna PS, Brown DL. The reverse superficial sural artery flap revisited for complex lower extremity and foot reconstruction. Plast Reconstr Surg Glob Open. 2015;3:e519.

Li B, Chang SM, Du SC, Zhuang L, Hu SJ. Distally based sural Adipofascial turnover flap for coverage of complicated wound in the foot and ankle region. Ann Plast Surg. 2020;84:580–7.

Gumener R, Zbrodowski A, Montandon D. The reversed fasciosubcutaneous flap in the leg. Plast Reconstr Surg. 1991;88:1034–41 discussion 1042-1033.

Parrett BM, Talbot SG, Pribaz JJ, Lee BT. A review of local and regional flaps for distal leg reconstruction. J Reconstr Microsurg. 2009;25:445–55.

Li P, Li Z, Shen G. Distally based posterior Tibial artery perforator flaps for reconstruction of the defects in Achilles region. Ann Plast Surg. 2019;83:452–4.

Scaglioni MF, Rittirsch D, Giovanoli P. Reconstruction of the heel, middle foot sole, and plantar forefoot with the medial plantar artery perforator flap: clinical experience with 28 cases. Plast Reconstr Surg. 2018;141:200–8.

Liau JE, Pu LL. Reconstruction of a large upper tibial wound extending to the knee with a free latissimus dorsi flap: optimizing the outcomes. Microsurgery. 2007;27:548–52.

Zeiderman MR, Bailey CM, Arora A, Pu LLQ. Anterior tibial vessel turnover as recipient vessel for complex free tissue transfer around the knee. J Plast Reconstr Aesthet Surg. 2020;73:1897–916.

Stranix JT, Lee ZH, Jacoby A, Anzai L, Avraham T, Thanik VD, et al. Not all Gustilo type IIIB fractures are created equal: arterial injury impacts limb salvage outcomes. Plast Reconstr Surg. 2017;140:1033–41.

Stranix JT, Borab ZM, Rifkin WJ, Jacoby A, Lee ZH, Anzai L, et al. Proximal versus distal recipient vessels in lower extremity reconstruction: a retrospective series and systematic review. J Reconstr Microsurg. 2018;34:334–40.

Rodriguez ED, Bluebond-Langner R, Copeland C, Grim TN, Singh NK, Scalea T. Functional outcomes of posttraumatic lower limb salvage: a pilot study of anterolateral thigh perforator flaps versus muscle flaps. J Trauma. 2009;66:1311–4.

Hong JP, Shin HW, Kim JJ, Wei FC, Chung YK. The use of anterolateral thigh perforator flaps in chronic osteomyelitis of the lower extremity. Plast Reconstr Surg. 2005;115:142–7.

Zhang AY, Cholok D, Lee GK. Progressive trends in timing and imaging of lower extremity reconstruction. Plastic and Aesthetic Research. 2019;6:30.

Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg. 2002;109:2219–26 discussion 2227-2230.

Kludt N, Pu LLQ. The clinical application of free-style cutaneous perforator flaps. Eur J Plast Surg. 2015;38:71–6.

Song JW, Ben-Nakhi M, Hong JP. Reconstruction of lower extremity with perforator free flaps by free style approach in pediatric patients. J Reconstr Microsurg. 2012;28:589–94.

Abdelfattah U, Power HA, Song S, Min K, Suh HP, Hong JP. Algorithm for free perforator flap selection in lower extremity reconstruction based on 563 cases. Plast Reconstr Surg. 2019;144:1202–13.

Dorfman D, Pu LL. The value of color duplex imaging for planning and performing a free anterolateral thigh perforator flap. Ann Plast Surg. 2014;72:S6–8.

Blondeel PN, Beyens G, Verhaeghe R, Van Landuyt K, Tonnard P, Monstrey SJ, et al. Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg. 1998;51:202–9.

Tashiro K, Harima M, Yamamoto T, Narushima M, Koshima I. Locating recipient perforators for perforator-to-perforator anastomosis using color Doppler ultrasonography. J Plast Reconstr Aesthet Surg. 2014;67:1680–3.

Onoda S, Azumi S, Hasegawa K, Kimata Y. Preoperative identification of perforator vessels by combining MDCT, doppler flowmetry, and ICG fluorescent angiography. Microsurgery. 2013;33:265–9.

Jakubietz RG, Schmidt K, Bernuth S, Meffert RH, Jakubietz MG. Evaluation of the intraoperative blood flow of Pedicled perforator flaps using Indocyanine green-fluorescence angiography. Plast Reconstr Surg Glob Open. 2019;7:e2462–2.

Heitmann C, Levin LS. The Orthoplastic approach for Management of the Severely Traumatized Foot and Ankle. J Trauma Acute Care Surg. 2003;54:379–90.

Yazar S, Lin CH, Wei FC. One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg. 2004;114:1457–66.

Abula A, Yushan M, Ren P, Abulaiti A, Ma C, Yusufu A. Reconstruction of soft tissue defects and bone loss in the tibia by flap transfer and bone transport by distraction osteogenesis: a case series and our experience. Ann Plast Surg. 2020;84:S202–s207.

Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg. 2009;124:1529–44.

Lecours C, Saint-Cyr M, Wong C, Bernier C, Mailhot E, Tardif M, et al. Freestyle pedicle perforator flaps: clinical results and vascular anatomy. Plast Reconstr Surg. 2010;126:1589–603.

Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987;40:113–41.

Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. 1989;42:645–8.

Wei FC, Mardini S. Free-style free flaps. Plast Reconstr Surg. 2004;114:910–6.

Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg. 1984;37:149–59.

Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg. 2009;123:230–5.

Hong JP, Sun SH, Ben-Nakhi M. Modified superficial circumflex iliac artery perforator flap and supermicrosurgery technique for lower extremity reconstruction: a new approach for moderate-sized defects. Ann Plast Surg. 2013;71:380–3.

Pu LL, Wang C. Future perspectives of pre-expanded perforator flaps. Clin Plast Surg. 2017;44:179–83.

Wang C, Zhang J, Hyakusoku H, Song P, Pu LL. An overview of pre-expanded perforator flaps: part 2, clinical applications. Clin Plast Surg. 2017;44:13–20.

Burnier P, Niddam J, Bosc R, Hersant B, Meningaud JP. Indocyanine green applications in plastic surgery: a review of the literature. J Plast Reconstr Aesthet Surg. 2017;70:814–27.

Koshimune S, Shinaoka A, Ota T, Onoda S, Kimata Y. Laser-assisted Indocyanine green angiography aids in the reconstruction of Gustilo grade IIIB open lower-limb fractures. J Reconstr Microsurg. 2017;33:143–50.

Monahan J, Hwang BH, Kennedy JM, Chen W, Nguyen GK, Schooler WG, et al. Determination of a perfusion threshold in experimental perforator flap surgery using indocyanine green angiography. Ann Plast Surg. 2014;73:602–6.

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