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• W2734921914 abstract "Sir: I agree with and appreciate most of the comments made by Agostini et al. about the article.1 Nevertheless, certain points have to be clarified. The authors mention that only a very few patients with intraoral defects need reconstruction by means of a flap with limited thickness. However, it is not compatible in the scenario of my clinical practice. The oral cavity can be divided into several subunits. Reconstruction of each subunit requires special consideration of both the extent of the defect and the donor flap characteristics based on the principle of restoring the integrity and the function and form. For example, a thin and pliable flap such as a radial forearm flap is mostly indicated for reconstruction of the hemiglossectomy defect to preserve the mobility of the residual tongue. The idea is totally different for the subtotal and total glossectomy defect, which requires reconstruction using a flap with adequate bulkiness to maintain palatoglossal contact for speech and swallowing. An anterolateral thigh flap with inclusion of the vastus lateralis muscle is the preferred method in our institute.2 For buccal mucosa, retromolar trigone, hard palate, and oropharynx defects, a bulky flap may be frequently bitten by teeth and also result in unintelligible speech, difficulty swallowing, and chronic aspiration. That is why several primary thinning techniques have been developed for the anterolateral thigh flap, including the suprafascial harvest method.1,3–5 As for the outcome, whether anchoring of the deep fascia from the anterolateral thigh flap to the recipient tissue can prevent flap sagging is not yet known. We all understand that the human face is supported by multiple ligamentous structure but still cannot escape the fate of sagging over time. Although some articles have reported good results in the short term, the long-term outcome remains in question.6,7 Regarding the donor site, it is true that the suprafascial anterolateral thigh flap harvest method cannot avoid skin graft; however, preservation of the deep fascia can prevent functional impairment resulting from adhesion between skin graft and the muscle junction by maintaining the smooth gliding surface. Preservation of the deep fascia can also eliminate the concern that deep fascia harvest may result in persistent lower leg weakness.8 However, closure of the fascia may not prevent but would potentially cause compartment syndrome. Although we did not experience compartment syndrome in our suprafascial anterolateral thigh flap case series, this devastating condition should be kept in mind. In conclusion, the anterolateral thigh flap is versatile, with numerous modifications.9 The suprafascial harvest method provides a thinner flap with minimized donor-site morbidity.1 The decision regarding which harvest method is to be used should be determined by the extent of defects, the patient’s comorbidity, adjuvant radiotherapy, and the surgeon’s experience. Not only is the principle of “replacing like tissue with like” followed, but also “harvesting only the tissues needed for reconstruction” is considered. DISCLOSURE The author has no financial conflicts or commercial associations to disclose. Yen-Chou Chen, M.D.Department of Plastic and Reconstructive SurgeryBody Science & Metabolic Disorders International Medical CenterChina Medical University HospitalNo. 2, Yude RoadNorth DistrictTaichung City 404, Taiwan[email protected]" @default.
• W2734921914 created "2017-07-21" @default.
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• W2734921914 date "2017-03-01" @default.
• W2734921914 modified "2023-09-26" @default.
• W2734921914 title "Reply" @default.
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• W2734921914 doi "https://doi.org/10.1097/prs.0000000000003104" @default.
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