Journal Logo

LETTERS

The Butterfly Design as an Alternative to the “Double-A” Bilateral Flaps for the Treatment of Large Sacral Defects

Reply

Prado, Arturo M.D.

Author Information
Plastic and Reconstructive Surgery: April 2008 - Volume 121 - Issue 4 - p 1514-1515
doi: 10.1097/01.prs.0000305368.14393.72
  • Free

Sir:

I truly appreciate Weum and de Weerd’s communication. It is interesting that the authors add to Conway and Griffith’s 1956 principles for the management of pressure sores, that “whenever possible, protective sensibility should be provided as well”; this statement should be attributed to Kroll and Rosenfield for their article “perforator flap sensibility concept.”1

The butterfly design based on two lumbar perforator arteries was published in 2002 and is unique.2 The authors should then have at least a 5-year follow-up, a number of cases, and a rate of complications that we should be aware of before attempting this surgery, as I believe that this design should be used in selected cases (also shared with the double-A flap concept) with advance knowledge of the failure rates of a single perforator living flap.

The blood supply reliability of the double-A flaps is based on evidence,3 as each gluteal area originating from intact superior and inferior gluteal arteries will have 20 to 25 perforators for each side, as described by Koshima et al.4

Arturo Prado, M.D.

School of Medicine

Postgraduate School

Plastic Surgery

Hospital Jose Joaquin Aguirre

University of Chile

Santiago, Chile

pradoplast@yahoo.com

REFERENCES

1. Kroll, S. S., and Rosenfield, L. Perforator-based flaps for low posterior midline defects. Plast. Reconstr. Surg. 81: 561, 1988.
2. De Weerd, L., and Weum, S. The butterfly design: Coverage of a large sacral defect with two pedicled lumbar artery perforator flaps. Br. J. Plast. Surg. 55: 251, 2002.
3. Prado, A., Ocampo, C., Danilla, S., Valenzuela, G., Reyes, S., and Guridi, R. A new technique of “double-A” bilateral flaps based on perforators for the treatment of sacral defects. Plast. Reconstr. Surg. 119: 1481, 2007.
4. Koshima, I., Moriguchi, T., Soeda, S., Kawata, S., Ohta, S., and Ikeda, A. The gluteal perforator-based flap for repair of sacral pressure sores. Plast. Reconstr. Surg. 91: 678, 1993.

Section Description

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.

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.

©2008American Society of Plastic Surgeons