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Egro et al. Plast Aesthet Res 2019;6:14 Plastic and
DOI: 10.20517/2347-9264.2019.30 Aesthetic Research

Commentary Open Access

Commentary of “skin grafting the vascular pedicle:
a useful technique to avoid microvascular collapse

in free tissue transfer for limb salvage”

Francesco M. Egro, Eva Roy, Mario G. Solari

Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550 Terrace Street 6B Scaife Hall Pittsburgh, Pittsburgh,
PA 15261, USA.

Correspondence to: Dr. Francesco M. Egro, Department of Plastic Surgery, University of Pittsburgh Medical Center, 3550
Terrace Street 6B Scaife Hall Pittsburgh, Pittsburgh, PA 15261, USA. E-mail: francescoegro@gmail.com

How to cite this article: Egro FM, Roy E, Solari MG. Commentary of “skin grafting the vascular pedicle: a useful technique to avoid
microvascular collapse in free tissue transfer for limb salvage”. Plast Aesthet Res 2019;6:14.
http://dx.doi.org/10.20517/2347-9264.2019.30

Received: 25 Jun 2019 Accepted: 10 Jul 2019 Published: 22 Jul 2019
Science Editor: Raúl González-García Copy Editor: Jia-Jia Meng Production Editor: Jing Yu

We commend the authors on an excellent paper comparing the outcomes of microvascular transfers that
[1]
utilized a skin graft for closure over the pedicle to a tension-free primary closure . The retrospective
cohort study of 71 patients found no significant difference in the rate of post-operative complications
between the two groups. The authors concluded that skin graft closure over free flaps and pedicles may be
an alternative technique to prevent compression in extremity free tissue transfers.

Free flaps offer the flexibility of mobilizing vascularized tissue to cover complex traumatic defects. It is
important to emphasize the key principle in microsurgical reconstruction of traumatic limbs is performing
[2]
the microvascular anastomosis well outside the zone of injury . This should be done to prevent free flap
[3]
failure typically due to arterial thrombosis or inadequate venous outflow .
We agree that unfortunately the inability of obtaining primary closure may occur in microsurgical
reconstruction of limbs and we commend the authors for providing evidence for a potential alternative.
The inability to obtain primary closure occurs when local tissue inflammation and trauma leads to an
[4]
increase in edema , which in turn makes primary closure a challenge. In our experience, the inability to
obtain primary closure is predominantly associated with free flaps to cover upper extremity defects due
[5]
to the lack of mobility of tissues (especially around the wrist) . It would have been interesting to see if an
anatomical dominance existed in the study and if the complication rates differed based on them.

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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and indicate if changes were made.

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