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- W4256616228 abstract "Sir: We acknowledge the comments and suggestions from Li and Luan regarding our article entitled “Long-Term Results of a One-Stage Secondary Debulking Procedure after Flap Reconstruction for Foot” (Plast Reconstr Surg. 2016;138:923–930).1 In the procedure described, the full-thickness skin graft harvested from the flap is grafted onto the well-vascularized fascia after debulking of the excess tissue, with the underlying vascular pedicle remaining untouched.1 For most of the procedures performed, we have based the interval time of first reconstruction and debulking on two clinical parameters, namely (1) general status of wound healing at the reconstructed site and (2) completion of the orthopedic procedure (if present). Our main aim is to help facilitate the early physical rehabilitation of our patients. Although flap reconstruction cannot completely replicate the complex nature of the hind-foot glabrous skin dedicated to weight-bearing and resistant to shearing forces because of tissue instability and excess bulk,2 the one-stage secondary debulking procedure increases the number of techniques available to the reconstructive surgeon to greatly improve the three-dimensional contour and gait stability of the heel area by allowing precise removal of excess subcutaneous tissue. Furthermore, it still provides two layers of protection to the weight-bearing surface: the remaining fascia and the full-thickness skin graft. This leads to a decreased ulceration rate, and this can be achieved without the need for additional refinement procedures. Although there is an increasing use of human acellular dermal matrix in facilitating reconstruction in the extremities,3 in our opinion, its use may still be limited in areas with more superficial defects. Wounds with more extensive tissue loss and exposure of vital structures may still benefit more with flap reconstruction. DISCLOSURE The authors have no financial conflicts or commercial associations to disclose. Tsan-Shiun Lin, M.D.Richard Quing, M.D.Department of Plastic and Reconstructive SurgeryKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiung, Taiwan" @default.
- W4256616228 created "2022-05-12" @default.
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- W4256616228 date "2017-02-01" @default.
- W4256616228 modified "2023-09-23" @default.
- W4256616228 title "Reply" @default.
- W4256616228 cites W1974954003 @default.
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- W4256616228 doi "https://doi.org/10.1097/prs.0000000000002979" @default.
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