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• W4249838237 abstract "Sir: We read with interest the letter by Pan at al., and we congratulate the authors for the waveform-designed lateral circumflex femoral artery perforator flap. As shown by the images provided, their proposed design allowed a complete and well-tailored coverage of an extensive defects spanning from the posterior and medial lower third of the leg to the lateral plantar forefoot, permitting at the same time, direct closure of the donor site at the level of the thigh. Nevertheless, however interesting this solution may be, we have the feeling that we are simply talking about different scenarios and different surgical needs. First, in our series, as specified in the title,1 we wanted to investigate the different uses and the versatility of one specific flap, namely the medial plantar artery perforator flap, in reconstructing small and medium-size defects of the weight-bearing areas of the foot. There is no question that large defects would require proportionally larger solutions, and the medial plantar artery–related flaps would automatically be excluded by the decision-making process. Our maximum flap size was 9.5 × 5.5 cm and, although this can be considered quite a large flap in its category, has nothing to do with the 30 × 8.5-cm anterolateral thigh flap reported by the authors. Moreover, even if it is true that the ankle region may be exposed to shearing forces by simply wearing shoes and a durable coverage is always advisable, it has, again, just little in common with the plantar aspect of the foot that must withstand the person’s total body weight. The unique histologic and structural features of the plantar skin that permit absorption of shock and resistance to shearing forces during ambulation have been appreciated for a long time2 and continue to be, as they always have been, not replaceable by tissues harvested from other body regions. In conclusion, we agree with Dr. Pan that the risk of compromising the sensation of the operated foot should never be underestimated, especially when this extremely delicate surgery is performed by less-experienced surgeons. However, in our rather long series, we received positive feedback from patients. Besides not complaining of relevant sensation disturbances, they really appreciated the scar burden being entirely confined to a single, hidden area of the body. DISCLOSURE The authors have no financial conflicts or commercial associations to disclose in relation to the content of this communication. Alberto Franchi, M.D.Mario F. Scaglioni, M.D.Department of Plastic and Hand SurgeryUniversity Hospital ZurichZurich, Switzerland" @default.
• W4249838237 created "2022-05-12" @default.
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• W4249838237 date "2018-11-01" @default.
• W4249838237 modified "2023-09-26" @default.
• W4249838237 title "Reply" @default.
• W4249838237 cites W2012965026 @default.
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• W4249838237 doi "https://doi.org/10.1097/prs.0000000000004943" @default.
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