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Abstract

Sir: We thank Pinder et al. for the insightful comments made in response to our article. We agree with their microsurgical methods and believe that careful perioperative management is very important. Keeping the patient warm, well perfused, and comfortable throughout the perioperative period is favorable. Preventing hypothermia is particularly important for preventing surgical-site infection.1 In addition, noninvasive objective evaluations are necessary for flap management after the operation. Our goal is to standardize the pin-prick test by introducing a fine-needle kit for the measurement of blood glucose and determine whether there is bleeding in the flaps every 6 hours after the operation.2,3 This will allow an evaluation of congestion based on the amount and the color of hemorrhage comparatively earlier than judging the tone change of the flap subjectively. A recent review of all microvascular anastomoses (n = 492) carried out in our institution between 2002 and 2010 revealed that eight free flaps were reexplored and six were total flap losses. The rate of total flap loss was 1.2 percent. Takuya Koizumi, M.D. Masahiro Nakagawa, M.D. Shogo Nagamatsu, M.D. Shuji Kayano, M.D. Satoshi Akazawa, M.D. Division of Plastic and Reconstructive Surgery Shizuoka Cancer Center Hospital Shizuoka, Japan