Eur J Plast Surg (2001) 24:258 DOI 10.1007/s002380100261 AUTHOR’S REPLY W. Boeckx Published online: 10 August 2001 © Springer-Verlag 2001 I fully agree with Dr. Baker’s invited commentary. He graft could only be 2–3 mm centered on the alar carti- emphasizes the requirements for a composite graft: it lage. In cases in which a differential level of resection should be no farther than 1 cm from the source of its was required on the outer skin surface relative to the mu- blood supply, and it is important to increase raw surface cosa lining we also have opted for nonvascularized com- available for revascularization. This, for us, is exactly posite grafts. These were also successful. The reason for the indication for a free flap in cases in which there is no this publication, however, is the much less frequent situ- raw surface, where the transection of the alar cartilage is ation in which mucosa and skin resection do not allow at the same level at the skin margin as at the mucosal lin- any overlapping so that vascular anastomosis in the der- ing. Thus we have applied this microsurgical technique mis cannot develop. only in cases in which there is a trough and trough cut Furthermore, the advantage of a microvascular flap is through the alar rim at the same level so that the thick- that there is an immediate establishment of blood flow in ness or diameter of the contact area to the composite the graft. Also, as in the composite graft technique, an atraumatic technique and careful handling without crush- ing instruments is mandatory. The advantage of the mi- This reply refers to the invited commentary at http://dx.doi.org/ crosurgical procedure is that the recipient wound bed 10.1007/s002380100260 may be scarred because in the microsurgical transfer the revascularization takes place from the free flap to the W. Boeckx ( ) Department of Plastic and Reconstructive Surgery, surrounding scarred tissue. Hand Surgery and Microsurgery, The paper that we presented describe merely an alter- University Hospital of Maastricht, P. Debeylaan 25, native or an adjunct in difficult cases in which the re- Postbus 5800, 6202 AZ Maastricht, the Netherlands quirements for free chondrocutaneous grafts are not e-mail: firstname.lastname@example.org Tel.: +31-43-3877481, Fax: +31-43-3875485 met.
European Journal of Plastic Surgery – Springer Journals
Published: Sep 1, 2001
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