Microsurgery | 2019
Comments on “Reconstruction of an upper posterior thigh extensive defect with a free split‐anterolateral thigh (s‐ALT) flap by perforator‐to‐perforator anastomosis: A case report”
Abstract
Dear Editor, We read with interest the recently published case report authored by Scaglioni, Barth, and Giovanoli (2018) describing the use of a split anterolateral thigh (s-ALT) flap for reconstructing a complex defect on the patient s contralateral thigh. We would like to congratulate the authors for achieving such a good result for this challenging clinical scenario. We would just like to bring to the attention of the authors that we disagree on their definition of a perforator-to-perforator anastomosis. According to Koshima, Yamamoto, Narushima, Mihara, and Iida, 2010: “perforator flaps can be classified as long vascular pedicle perforator flaps (DIEP flaps, ALT and AMT flaps, TAP flaps); short T-pedicle perforator flaps, including a short T-shape segment of large vessels (DIEP or PUP flaps, ALT and AMT flaps, TFL flaps, SCIP flaps, radial artery perforator flap, snuffbox flaps, medial plantar flaps); and true perforator flaps [...] The true perforator has only perforators and nomain trunk vessels.” It can be clearly appreciated in Scaglioni et al. figure 2 (upper left) that the s-ALT flap was harvested based on 2 perforators connected by a segment of the descending branch of the lateral circumflex femoral artery (dLCFA). The same can be seen on the schematic representation in figure 3. According to Koshima et al., this design should not be classified as a true perforator flap, but as a perforator flap with a short T-shape segment of a large vessel. Considering this fact, even though if the recipient vessels are perforators of the contralateral dLCFA and vein, the anastomosis should not be considered to be perforator-to-perforator, but an anastomosis between a pedicle consisting on the flap dLCFA and a perforator on the recipient site. We believe that attaching to the widely accepted classifications in microsurgery is vital in order to preserve optimal reporting of experiences in our subspecialty and avoid unnecessary misunderstanding. CONFLICT OF INTEREST