Reply

Abstract

Sir: Thank you for the opportunity to reply to the letter by Dr. Acartürk. We reported in the March 2010 issue of Plastic and Reconstructive Surgery a case of banking a hemiabdominal deep inferior epigastric perforator (DIEP) flap for “high-risk patients.”1 We sought to describe this as a unique and original technique for preserving a perforator flap while awaiting oncologic clearance of a tumor that was being primarily reconstructed at a single recipient site. The title of the article and the indication for the procedure certainly demonstrated this, and clearly differed from the planned staging of a bilateral breast reconstruction, in which two separate defects were reconstructed, as reported by Dr. Acartürk.2 Although Dr. Acartürk's case was reported in 2008, we performed our reported case in November of 2004, with the original photograph and dates from the camera shown in Figure 1. We have actually performed a series of these procedures since 1999, with the first procedure performed in February of 1999 and the original photograph and date from the camera of the first such procedure shown in Figure 2 (this is a 12-month follow-up photograph). However, where the concern appears to have arisen is the time between Dr. Acartürk's 2008 publication and our March of 2010 publication. We would like to point out that in fact we wrote our article before Dr. Acartürk's publication (in early 2008), and our article was submitted, accepted, and has been in press since 2008. He also claims that we referenced a 2009 article in our article—we certainly did not, and there is no mention of this reference in our article,3 given that our submission was well before that. There were certainly no “intentional” omissions from the literature, and a thorough literature review was indeed performed at the time of initial writing, before Dr. Acartürk's case was published or presented.Fig. 1.: Original photograph of the published case example of a “surplus,” banked DIEP flap performed in November of 2004, in which chest wall reconstruction with a right-sided hemiabdominal DIEP flap was performed for locally advanced lymphangiosarcoma, and closure of the abdominal wall was performed with a left DIEP advancement flap for subsequent use in the case of local recurrence.Fig. 2.: Original photograph of our first case of a “surplus,” banked DIEP flap performed in February of 1999 for unilateral breast reconstruction, demonstrating the 12-month postoperative results.This must of course be taken in the context of the Plastic and Reconstructive Surgery Viewpoints section, which offers the ability to provide broad access to many ideas and techniques by limiting submissions to five references and 500 words, but which in turn can serve to limit the extent of literature review. However, given the nature of the different case reports in the current discussion, this is not highly relevant here. In addition, the dates of submission and acceptance are not listed in the Viewpoints section, which can confound the interpretation of dates. Finally, in terms of Dr. Acartürk's presentation of the case report at the European Federation of Societies for Microsurgery meeting, the presentation was not seen by any of the authors, and again the article was written well before this. We commend Dr. Acartürk for his earliest publication of such a technique, one which we have clearly found useful ourselves for some time, in a range of different clinical settings. Rafael Acosta, M.D. Department of Plastic Surgery Uppsala Clinic Hospital Uppsala, Sweden Warren M. Rozen, M.B.B.S., B.Med.Sc., P.G.Dip.Surg.Anat., Ph.D. Brockhoff Reconstructive Plastic Surgery Research Unit Department of Anatomy and Cell Biology University of Melbourne Parkville, Victoria, Australia Iain S. Whitaker, B.A.(Hons.), M.A.(Cantab.), M.R.C.S. Department of Plastic, Reconstructive, and Burns Surgery Welsh National Plastic Surgery Unit Morriston Hospital Swansea, United Kingdom