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• W3082304819 abstract "Sir: We read the article entitled “The Muscle-Sparing Descending Branch Latissimus Dorsi Free Flap for Lower Extremity Reconstruction” by Kurlander et al.1 with great interest. The authors are to be congratulated for furthering our knowledge regarding free flaps for lower extremity reconstruction. We agree with the authors that this method indeed is an available option. However, we would like to express our considerations regarding this study. First, in this study, the authors describe the ankle joint as the second site of injury covered by a muscle-sparing descending branch latissimus dorsi free flap. Ankle reconstruction aims to restore weight-bearing areas and provide a sensitive soft tissue. The recovery of proprioceptive sensation around the ankle joint is related directly to postoperative functional rehabilitation. However, the sensory function of the flap was not evaluated in this study. Sensory dysfunction around the ankle joint may lead to unstable walking, sprained ankles, giving way, and fear of walking. Therefore, the reconstruction of sensory function around the ankle joint is an important consideration when selecting the reconstruction procedure.2 Second, for the soft-tissue defect around the joint, especially around the ankle joint, preventing postoperative joint contracture is very important. In this study, the authors used split-thickness skin grafting, which has the advantage of good survival; however, skin retraction after survival is also one of the major complications.3 A secondary procedure would be needed in the ankle with severe skin contracture. Therefore, it should be taken into account for coverage of the defect around the ankle. Full-thickness skin grafts or flaps are recommended for coverage of the defect around the ankle joint, compared with split-thickness skin grafts. Third, among the 11 cases of ankle defect and seven cases of foot defect reported by the authors, it is not known whether there were cases with defects in the weight-bearing area or ankle friction region (e.g., the anterior ankle). Providing stable and durable soft tissue is key information that needs to be paid attention to for the reconstruction of these two special areas. Several studies have identified higher rates of ulceration and breakdown complications in muscle flaps than in fasciocutaneous flaps used in reconstructing the foot and ankle regions.4,5 Therefore, a wear-resistant flap with a robust surface should be selected for coverage of defects in the foot and ankle. ACKNOWLEDGMENTS Grants from the Jiangsu Provincial Medical Youth Talent Program (QNRC2016393) and Six Talent Peaks Project in Jiangsu Province (2019-WSW-173) were received for this publication. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication." @default.
• W3082304819 created "2020-09-08" @default.
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• W3082304819 date "2020-08-31" @default.
• W3082304819 modified "2023-09-23" @default.
• W3082304819 title "The Muscle-Sparing Descending Branch Latissimus Dorsi Free Flap for Lower Extremity Reconstruction" @default.
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• W3082304819 doi "https://doi.org/10.1097/prs.0000000000007302" @default.
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