Skip Navigation LinksHome > March 2013 - Volume 131 - Issue 3 > Reply: “Image-Guided” Perforator Flaps versus “Free-Style”...
Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e31827c72a3
Letters

Reply: “Image-Guided” Perforator Flaps versus “Free-Style” Perforator Flaps: Where Is the Evidence?

Rozen, Warren M. M.B.B.S., M.D., Ph.D.; Paddle, Alenka M. M.B.B.S.; Chubb, Daniel M.B.B.S.; Wilson, Jeremy M.B.B.S.; Grinsell, Damien M.B.B.S.; Ashton, Mark W. M.B.B.S., M.D.

Free Access
Article Outline
Collapse Box

Author Information

Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, University of Melbourne, Parkville, Victoria, Australia

Correspondence to Dr. Rozen, Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Room E533, Department of Anatomy and Cell Biology, University of Melbourne, Grattan Street, Parkville, Victoria 3050, Australia warrenrozen@hotmail.com

Back to Top | Article Outline

Sir:

Drs. Basu and Sharma make some interesting points in relation to the anatomy and planning of perforator flaps and in terms of studies exploring their incorporation into clinical practice.1 We recently reported our experience with the use of preoperative imaging to plan locoregional perforator flaps, and highlighted the benefits we subjectively obtained with this planning.2

Figure. No caption a...
Figure. No caption a...
Image Tools

In the past, we have undertaken such flaps without imaging, basing the central location of the flaps on the fascial penetration pattern of perforators alone and basing flap dimensions on long-held concepts of length-to-width ratios. We have since found that the use of new imaging technologies that can map subcutaneous branching patterns can improve the survival of the tips of the flaps by converting “random” intrinsic vasculature into “axial” intrinsic vasculature. It is unclear from the letter by Drs. Basu and Sharma whether this was made clear to the authors in our original article. We feel that axial pattern and random pattern extensions of the perforator flap concept can facilitate improved design for improved survival. To answer the first point of the authors, a stellate pattern perforator planned in this fashion can have a design that extends from the central perforator in multiple directions—which can enable a flap to be designed in a range of single directions, a bilobed pattern along two branches, or any number of patterns along the course of such branches.

The authors also suggest randomized trials or higher level studies to improve the evidence attributable to such techniques. Although this is true, and evident throughout research in surgery, we made it clear from the outset that this was a cohort study and designated the study a “Diagnostic III” level study, according to the guidelines of all Plastic and Reconstructive Surgery submissions. Lastly, although the suggestion that preoperative imaging is expensive is relatively true, we feel that cost alone should not preclude the use of such advances in surgery from use either clinically or in research. Individual surgeons and institutions can then incorporate such techniques into their practice according to their resources.

Warren M. Rozen, M.B.B.S., M.D., Ph.D.

Alenka M. Paddle, M.B.B.S.

Daniel Chubb, M.B.B.S.

Jeremy Wilson, M.B.B.S.

Damien Grinsell, M.B.B.S.

Mark W. Ashton, M.B.B.S., M.D.

Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, University of Melbourne, Parkville, Victoria, Australia

Back to Top | Article Outline
DISCLOSURE

The authors have no financial interest to declare in relation to the content of this communication.

Back to Top | Article Outline

REFERENCES

1. Basu A, Sharma AK. “Image-guided” perforator flaps versus “free-style” perforator flaps: Where is the evidence? Plast Reconstr Surg. 2013;131:444e–445e.

2. Rozen WM, Paddle AM, Chubb D, Wilson J, Grinsell D, Ashton MW. Guiding local perforator flaps with preoperative imaging: Revealing perforator anatomy to improve flap design. Plast Reconstr Surg. 2012;130:130–134.

Back to Top | Article Outline
GUIDELINES

Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article's publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor.

Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested.

Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS' enkwell, at www.editorialmanager.com/prs/.

We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium.

The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence.

The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.

©2013American Society of Plastic Surgeons

Login

Article Tools

Images

Share