We would like to thank Dr. Townley and colleagues for their comments regarding our study.1 We agree that the anterolateral thigh free flap is an excellent choice in terms of donor-site morbidity, even when a large skin paddle is required. We feel that skin grafting of the thigh is generally better tolerated than skin grafting defects of the back or abdomen following harvest of latissimus dorsi or rectus abdominis myocutaneous free flaps with wide skin paddles that cannot be closed primarily, for example.
As Dr. Townley and colleagues have described, we also find that the vacuum-assisted closure negative-pressure wound dressing makes an excellent bolster following skin grafting of the anterolateral thigh free flap donor site.2 We leave the vacuum-assisted closure dressing on for 5 to 7 days. In addition, we have found it helpful to place the patient in a knee-immobilizing splint during ambulation for approximately 2 weeks to minimize flexion and extension of the knee, which can cause shear-related loss of the skin graft because of contraction and relaxation of the quadriceps muscles. One other caveat is that we do not close the proximal and distal portions of the donor site tightly or “purse-string” the donor-site wound, such that the rectus femoris and vastus lateralis muscles herniate above the level of the thigh skin before application of the skin graft. We feel that this leads to shearing of the graft at the wound edges, and earlier in our experience, we had problems with incomplete graft take when this was attempted.
The authors have no financial interest in the content of this reply or of the article being discussed.
Matthew M. Hanasono, M.D.
Roman J. Skoracki, M.D.
Peirong Yu, M.D.
Department of Plastic Surgery
University of Texas M. D. Anderson Cancer Center
1. Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients. Plast Reconstr Surg.
2. Blackburn JH II, Boemi L, Hall WW, et al. Negative-pressure dressings as a bolster for skin grafts. Ann Plast Surg.
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