We read with interest your recent report of donor-site morbidity in a large prospective series of anterolateral thigh flaps.1 The flap has many virtues, and the donor site is favorable. It was reassuring that donor-site skin grafts [33 of 220 cases (15 percent)] were well tolerated. In particular, partial graft loss was very low [one of 33 cases (3 percent)]. In our practice, we often use large anterolateral thigh flaps (which require donor-site grafting) to resurface defects where total wound cover takes precedence over donor-site considerations such as on the upper limb (Figs. 1 and 2). We feel it is preferable to have the skin graft on the donor site and not the defect.
We have found that graft take on the thigh can be unreliable, as immobilization is awkward and shear forces tend to result in graft slippage and incomplete take. We now immobilize grafts with vacuum-assisted closure dressings in the early postoperative period, which has significantly improved graft take.
Large anterolateral thigh flaps in which the donor site cannot be closed directly have a useful role in reconstructive surgery, and the need to graft the donor site should not prevent their use.
The authors confirm that there are no commercial or financial conflicts of interest associated with this communication.
William A. Townley, M.R.C.S.
Roderick L. R. Dunn, F.R.C.S.(Plast.)
Alex P. Crick, F.R.C.S.(Plast.)
Odstock Center for Burns, Plastic and Maxillofacial Surgery
Salisbury District Hospital
Salisbury, United Kingdom
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.
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