Microsurgery | 2021
Usefulness of a template‐based free flap planning for reconstruction of sarcoma defects
Abstract
Dear Editor, We read with great interest the article by Driessen et al. (2020) in which the authors show the usefulness of a template-based ALT flap for head and neck reconstruction. We compliment the authors for the effort produced to show how a standardized approach can improve both flap harvesting and insetting and we would like to present our experience with the template-based free flap planning for reconstruction of sarcoma defects. In our clinical practice, we routinely obtain a template from a sterile polyurethane foam (Biatain Coloplast, Humlebaek, Denmark), a dressing used for common wound management, which resembles thickness and pliability of the normal skin (its thickness is comparable to a thin free flap like radial forearm or superficial circumflex iliac perforator flap). The dressing is applied at the level of the wound to obtain a precise template of the defect to be reconstructed (Figure 1a), which is retailed taking in consideration the orientation of the defect, the location of the recipient vessels and the course and the desired length of the vascular pedicle (Figure 1b). Such information is marked on the template to simplify the reconstructive process. Then the template is placed on the donor site and the flap designed accordingly (Figure 1c), in order to guarantee a direct and easy flap insetting before or after microvascular anastomoses (Figure 1d). Wide resection of soft tissues sarcomas usually produces defects of significant size, whose reconstruction requires flaps of huge dimensions. In such cases, we make every possible effort to avoid the additional morbidity related to skin graft placement at the level of the