We appreciate the comments by Drs. Perez-Garcia, Ruiz-Cases, Baeza, Salmerón-González, and Simón-Sanz regarding our article.1 We feel that the approach we described goes a long way to decrease donor-site morbidity. The practical nature of a two-team approach (i.e., harvesting the fibula from one leg while another team prepares the recipient vessels and formulates the construct for fixation) makes for a crowded operating table. The relative morbidity of saphenous vein harvest is quite low and even can be performed endoscopically. More importantly, the fact that the patients can transfer immediately and avoid potential complications from the donor site remain appealing to our team. There certainly remains a place for contralateral vascularized fibular grafting from the contralateral leg when the fibula is unsuitable or vascular conditions preclude the use of the vascularized fibula from the same side as the abnormality. In these cases, we have used the contralateral leg with fabulous success similar to that of our colleagues from Valencia. We appreciate their comment and present our series as an alternative when this technique is possible.
The author has no financial interest to declare in relation to the content of this communication.
L. Scott Levin, M.D.
Department of Orthopaedic Surgery
Division of Plastic Surgery
University of Pennsylvania
1. Piccolo PP, Ben-Amotz O, Ashley B, Wapner KL, Levin LS. Ankle arthrodesis with free vascularized fibula autograft using saphenous vein grafts: A case series. Plast Reconstr Surg. 2018;142:806–809.
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