Reply: ITADE flap after mastectomy for locally advanced breast cancer: A good choice for mid‐sized defects of the chest wall, based on a systematic review of thoracoabdominal flaps

Abstract

To the Editor, I am writing this letter to note a mistake in the systematic review by Vieira et al on the use of a thoracoabdominal flap to correct large areas of chest wall resection after locally advanced breast cancer. In that article, the author classifies thoracoabdominal flaps as dermofat and fasciocutaneous and describes the thoracoepigastric flap as dermofat and without pedicle, identified by referencing the article of Burattini et al. In the introduction of Burattini et al’s article, it is stressed that the thoracoepigastric flap is fasciocutaneous and axial based on the system of musculocutaneous perforators of the deep superior epigastric artery. We emphasize that the flap is axial from the lateral border of the rectus abdominis to the anterior axillary line, and beyond this line, the flap becomes random (subdermal plexus), as published by Davis et al, which may have been the reason for the misinterpretation of Vieira et al. Mathes and Nahai classified the thoracoepigastric flap as type C fasciocutaneous. In accordance with Davis et al and Mathes and Nahai, Burattini et al report in the surgical technique that inclusion of the deep fascia under the flap is essential for flap viability. The largest flap described by Burattini et al was 25 × 12 cm, which would be totally impractical in the case of a dermofat flap with random vascularization. The purpose of Burattini et al’s article is to report the efficacy and safety of a new thoracoepigastric flap format with the patient in semi‐Fowler position during surgery and not to describe a new flap. The vascular characteristics and classification of this flap as fasciocutaneous have previously been established. We would like this erratum to be published to prevent surgeons who have access to the article by Vieira et al from making a thoracoepigastric flap without the muscle fascia, as this may result in high rates of necrosis.