Letters
LETTERS
GUIDELINES
Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor. Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested. Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/. We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium. The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence. The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.
Letters Letter
An Algorithm for Oncologic Scalp Reconstruction Randomized Controlled Trial Comparing Sir: e read with Quality interest your article oncologic Health-Related of Life in about Patients 1 reconstruction the scalp. agree with you Undergoing VerticalofScar versusWe Inverted that an algorithm is necessary to facilitate the surgical T–Shaped Reduction Mammaplasty
W
planning after radical oncologic excision. Radical surSir: gical resection is the most important curative action, e read with great interest the results of the imporand every surgeon has to perform it every time. tant trial comparing patient satisfaction between Many techniques are available today to reconstruct vertical and inverted-T breast reductions.1 We comthe scalp. We think that where there are full-thickness mend the authors on conducting one of the very bone defects or dura defects, microsurgical flaps are few known level I studies in reduction mammaplasty necessary, but when there is a soft-tissue defect of the surgery. scalp, there is the possibility of covering the loss of subAlthough the authors stress that they made stance using a dermal regeneration template, such as no attempt to evaluate aesthetic outcome, 2data on Integra (Integra LifeSciences, Plainsboro, N.J.). Our ex-
W
Copyright ©2011 © 2014by bythe theAmerican AmericanSociety Societyof of Plastic Plastic Surgeons Surgeons Copyright
216e
complications would available in there a randomized perience suggests that inbe cancer patients is the posstudy comparing two surgical noofmatter sibility of tumor recurrence, andtechniques mobilization local what (or thethe question posed is. may It would therefore of flaps use of free flaps) compromise thebe posgreat benefit to all ifthe they would add a short note on sibility of controlling local tumor recurrence. theWe important complications encountered in the two have operated on 32 patients with scalp defects groups surface of this rare level I study. (mean area, 70.1 cm2) using Integra directly DOI: 10.1097/01.prs.0000437230.77434.e4 over the bone, under local anesthesia. The tumor excision included the periosteum Bassem in all cases, and M.D. adeNathan, quate de´bridement of the scalp wound down to bleedZachary Nash ing bone was performed by drilling of the outer table Riverside Hospital of the cortex. The artificial dermis was United graftedKingdom as in a London, classic full-thickness skin graft and a compressive tiedover dressing was placed on the Integra for 5 days. Correspondence to Dr. Nathan Riverside Hospital If clear surgical margins were found, a second opBrentside Executive eration was performed at an average period of 21 toPark 22 London TW8 9DR, United days after artificial dermis implantation. The Kingdom silicone [email protected] layer was removed, and ultrathin autografts, taken usually from the thigh with a dermatome, were applied to DISCLOSURE the neodermis. There was full graft in all cases.to We obtained The authors have no take financial interest declare in relagood and oncologic points of tion tooutcomes the contentfrom of thisaesthetic communication. view, with a mean follow-up of 12 months. In eight cases, we noted a recurrence very early under the skin REFERENCE graft or under the Integra. 1. Using ThomaIntegra A, Ignacyand TA, Duku et al. we Randomized skin EK, grafts, provide controlled durable trial comparing health-related quality of life patients coverage of the scalp, thicker than direct skiningrafting vertical scar versus inverted T-shaped reduction on undergoing the skull or on granulation tissue, reducing the mammaplasty. Plast Reconstr Surg. likelihood of intraoperative or 2013;132:48e–60e. postoperative complications. This technique allows early detection of local tumor recurrence and therefore early tumor removal, with additional resections to obtain clear surgical margins before the final reconstruction is performed with Outcomes Analysis of Patients Undergoing split-thickness skin grafts over the dermal Autoaugmentation after Breast Implant substitute. Removal Our experience suggests that the use of a dermal reSir: generation template may be considered a successful rs. Gurunluoglu et al. perpetuate the notion of autooption for scalp reconstruction after tumor excision. augmentation.1 The authors claim that an inferior DOI: 10.1097/PRS.0b013e3182131abd parenchymal flap can restore volume in women after Bartolo Corradino, removal of breast implants, averaging 225.7 cm3.M.D. This 2 claim exceeds the previous estimate Graf et al. of Sara DibyLorenzo, M.D. 100Dipartimento to 200 cm3.diThe autoaugmentation concept dates Discipline Chirurgiche ed Oncologiche di Chirurgia Plastica3 back to Ribeiro’s descriptionSezione of a “prosthesis in natura” ` degli Studi di Palermo and has been published Universita previously in combination with explantation.4 The authors believe thatPalermo, adding Italy the BREAST-Q survey5 provides missing validation. Correspondence to Dr. Di Lorenzo The authors report that all patients were surDipartimento di Discipline Chirurgiche ed Oncologiche veyed preoperatively and atSezione least 6dimonths after surChirurgia Plastica Universita` degli di Palermo gery. A 100 percent compliance rate Studi is unusual. It is del Vespro 129 also unusual in a retrospective study Via to have preoperaItaly tive questionnaires available. Were 90127 these Palermo, investigators already in the habit of surveying [email protected] patients preoperatively with the BREAST-Q in 2007, the beginning of the study period,REFERENCES and 2 years before the BREAST-Q 5 1. Iblher Ziegler MC, Penna V, Eisenhardt SU, Stark GB, with the N, breast reduction module was published? Bannasch H. An algorithm for oncologic scalp reconstruction. Its developers caution that the “BREAST-Q scales Surg. 2010;126:450–459. arePlast notReconstr considered valid for patient groups that were 2. Corradino B, Di Lorenzo S, Leto Barone AA, Maresi E, not represented in the development process.”5 This Moschella F. Reconstruction of full thickness scalp defects limitation clearly extends to augmentation patients with after tumor excision in elderly patients: Our experience with complications explantation autoaugIntegra dermalundergoing regeneration template. J Plast and Reconstr Aesthet mentation. The improvement in scores may be related Surg. 2010;63:e245–e247.
D
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rich3/zpr-prs/zpr-prs/zpr00611/zpr4492-11z xppws
S 1 4/9/11 6:47 4/Color Figure(s): F1-7 Art: PRS203191 Input-nlm
1
LETTERS
GUIDELINES
Letters to the Editor, discussing material recently published in the Journal, are welcome. They will have the best chance of acceptance if they are received within 8 weeks of an article’s publication. Letters to the Editor may be published with a response from the authors of the article being discussed. Discussions beyond the initial letter and response will not be published. Letters submitted pertaining to published Discussions of articles will not be printed. Letters to the Editor are not usually peer reviewed, but the Journal may invite replies from the authors of the original publication. All Letters are published at the discretion of the Editor. Letters submitted should pose a specific question that clarifies a point that either was not made in the article or was unclear, and therefore a response from the corresponding author of the article is requested. Authors will be listed in the order in which they appear in the submission. Letters should be submitted electronically via PRS’ enkwell, at www.editorialmanager.com/prs/. We reserve the right to edit Letters to meet requirements of space and format. Any financial interests relevant to the content of the correspondence must be disclosed. Submission of a Letter constitutes permission for the American Society of Plastic Surgeons and its licensees and asignees to publish it in the Journal and in any other form or medium. The views, opinions, and conclusions expressed in the Letters to the Editor represent the personal opinions of the individual writers and not those of the publisher, the Editorial Board, or the sponsors of the Journal. Any stated views, opinions, and conclusions do not reflect the policy of any of the sponsoring organizations or of the institutions with which the writer is affiliated, and the publisher, the Editorial Board, and the sponsoring organizations assume no responsibility for the content of such correspondence. The Journal requests that individuals submit no more than five (5) letters to Plastic and Reconstructive Surgery in a calendar year.
Letters Letter
An Algorithm for Oncologic Scalp Reconstruction Randomized Controlled Trial Comparing Sir: e read with Quality interest your article oncologic Health-Related of Life in about Patients 1 reconstruction the scalp. agree with you Undergoing VerticalofScar versusWe Inverted that an algorithm is necessary to facilitate the surgical T–Shaped Reduction Mammaplasty
W
planning after radical oncologic excision. Radical surSir: gical resection is the most important curative action, e read with great interest the results of the imporand every surgeon has to perform it every time. tant trial comparing patient satisfaction between Many techniques are available today to reconstruct vertical and inverted-T breast reductions.1 We comthe scalp. We think that where there are full-thickness mend the authors on conducting one of the very bone defects or dura defects, microsurgical flaps are few known level I studies in reduction mammaplasty necessary, but when there is a soft-tissue defect of the surgery. scalp, there is the possibility of covering the loss of subAlthough the authors stress that they made stance using a dermal regeneration template, such as no attempt to evaluate aesthetic outcome, 2data on Integra (Integra LifeSciences, Plainsboro, N.J.). Our ex-
W
Copyright ©2011 © 2014by bythe theAmerican AmericanSociety Societyof of Plastic Plastic Surgeons Surgeons Copyright
216e
complications would available in there a randomized perience suggests that inbe cancer patients is the posstudy comparing two surgical noofmatter sibility of tumor recurrence, andtechniques mobilization local what (or thethe question posed is. may It would therefore of flaps use of free flaps) compromise thebe posgreat benefit to all ifthe they would add a short note on sibility of controlling local tumor recurrence. theWe important complications encountered in the two have operated on 32 patients with scalp defects groups surface of this rare level I study. (mean area, 70.1 cm2) using Integra directly DOI: 10.1097/01.prs.0000437230.77434.e4 over the bone, under local anesthesia. The tumor excision included the periosteum Bassem in all cases, and M.D. adeNathan, quate de´bridement of the scalp wound down to bleedZachary Nash ing bone was performed by drilling of the outer table Riverside Hospital of the cortex. The artificial dermis was United graftedKingdom as in a London, classic full-thickness skin graft and a compressive tiedover dressing was placed on the Integra for 5 days. Correspondence to Dr. Nathan Riverside Hospital If clear surgical margins were found, a second opBrentside Executive eration was performed at an average period of 21 toPark 22 London TW8 9DR, United days after artificial dermis implantation. The Kingdom silicone [email protected] layer was removed, and ultrathin autografts, taken usually from the thigh with a dermatome, were applied to DISCLOSURE the neodermis. There was full graft in all cases.to We obtained The authors have no take financial interest declare in relagood and oncologic points of tion tooutcomes the contentfrom of thisaesthetic communication. view, with a mean follow-up of 12 months. In eight cases, we noted a recurrence very early under the skin REFERENCE graft or under the Integra. 1. Using ThomaIntegra A, Ignacyand TA, Duku et al. we Randomized skin EK, grafts, provide controlled durable trial comparing health-related quality of life patients coverage of the scalp, thicker than direct skiningrafting vertical scar versus inverted T-shaped reduction on undergoing the skull or on granulation tissue, reducing the mammaplasty. Plast Reconstr Surg. likelihood of intraoperative or 2013;132:48e–60e. postoperative complications. This technique allows early detection of local tumor recurrence and therefore early tumor removal, with additional resections to obtain clear surgical margins before the final reconstruction is performed with Outcomes Analysis of Patients Undergoing split-thickness skin grafts over the dermal Autoaugmentation after Breast Implant substitute. Removal Our experience suggests that the use of a dermal reSir: generation template may be considered a successful rs. Gurunluoglu et al. perpetuate the notion of autooption for scalp reconstruction after tumor excision. augmentation.1 The authors claim that an inferior DOI: 10.1097/PRS.0b013e3182131abd parenchymal flap can restore volume in women after Bartolo Corradino, removal of breast implants, averaging 225.7 cm3.M.D. This 2 claim exceeds the previous estimate Graf et al. of Sara DibyLorenzo, M.D. 100Dipartimento to 200 cm3.diThe autoaugmentation concept dates Discipline Chirurgiche ed Oncologiche di Chirurgia Plastica3 back to Ribeiro’s descriptionSezione of a “prosthesis in natura” ` degli Studi di Palermo and has been published Universita previously in combination with explantation.4 The authors believe thatPalermo, adding Italy the BREAST-Q survey5 provides missing validation. Correspondence to Dr. Di Lorenzo The authors report that all patients were surDipartimento di Discipline Chirurgiche ed Oncologiche veyed preoperatively and atSezione least 6dimonths after surChirurgia Plastica Universita` degli di Palermo gery. A 100 percent compliance rate Studi is unusual. It is del Vespro 129 also unusual in a retrospective study Via to have preoperaItaly tive questionnaires available. Were 90127 these Palermo, investigators already in the habit of surveying [email protected] patients preoperatively with the BREAST-Q in 2007, the beginning of the study period,REFERENCES and 2 years before the BREAST-Q 5 1. Iblher Ziegler MC, Penna V, Eisenhardt SU, Stark GB, with the N, breast reduction module was published? Bannasch H. An algorithm for oncologic scalp reconstruction. Its developers caution that the “BREAST-Q scales Surg. 2010;126:450–459. arePlast notReconstr considered valid for patient groups that were 2. Corradino B, Di Lorenzo S, Leto Barone AA, Maresi E, not represented in the development process.”5 This Moschella F. Reconstruction of full thickness scalp defects limitation clearly extends to augmentation patients with after tumor excision in elderly patients: Our experience with complications explantation autoaugIntegra dermalundergoing regeneration template. J Plast and Reconstr Aesthet mentation. The improvement in scores may be related Surg. 2010;63:e245–e247.
D
www.PRSJournal.com www.PRSJournal.com
rich3/zpr-prs/zpr-prs/zpr00611/zpr4492-11z xppws
S 1 4/9/11 6:47 4/Color Figure(s): F1-7 Art: PRS203191 Input-nlm
1
