Journal of Plastic, Reconstructive & Aesthetic Surgery (2014) 67, e287ee288

CORRESPONDENCE AND COMMUNICATION

Response to: ‘Superiorepigastric artery perforatorflap for sternalosteomyelitis defectreconstruction’

Dear Sir,

With great interest we have read the article “Superiorepigastric artery perforator flap for sternal osteomyelitis

Figure 1 Perforasomes after selective injection of SEA- andDIEA-Perforators with methylene blue and India ink solution.Note the overlapping zones of the perforasomes (Reprintedwith permission from Schmidt et al.4).

DOI of original article: http://dx.doi.org/10.1016/j.bjps.2014.01.037.

http://dx.doi.org/10.1016/j.bjps.2014.07.0151748-6815/ª 2014 British Association of Plastic, Reconstructive and Aesthetic

defect reconstruction” by Wettstein et al.,1 who reportedtheir experiences in reconstruction of sternal defects withthe fasciocutaneous superior epigastric artery perforator(SEAP) flap. We congratulate the authors to their excellentwork and instructive case series.

Perforator flaps derived from the superior epigastricartery (SEA) have not been widely reported in the litera-ture. The first case report of SEAP flap by Hallock et al.2 in2005 was used for wound closure of a posttraumatic chestdefect. An anatomical study and preoperative perforatormapping with multidetector CT was carried out by Hamdiet al.3 in 2009.

To complete the scope of SEAP literature, we would liketo point out that our group has extensively studied anddocumented the perforator and perforasome anatomy ofthe upper abdomen through selective injection of perfo-rators.4 We demonstrated a reliable anatomy of SEAP flapsin the upper abdomen (Figures 1 and 2), which correspondswell with the existing study.3

Defects of the anterior thoracic wall represent a chal-lenging problem in reconstructive surgery, we believe thatthe information of our anatomical study is essential for the

Figure 2 SEA and DIEA perforasomes after selective perfo-rator injections. Note the subcostal SEAP perforasome orien-tation (Reprinted with permission from Schmidt et al.4).

Surgeons. Published by Elsevier Ltd. All rights reserved.

e288 Correspondence and communication

reconstructive surgeon in order to plan and execute pedi-cled perforator flaps from the upper abdominal region withmore safety and confidence.

Conflict of interest

None.

Funding

None.

Ethical approval

N/A.

References

1. Wettstein R, Weisser M, Schaefer DJ, Kalbermatten DF. Superiorepigastric artery perforator flap for sternal osteomyelitis defectreconstruction. J Plastic Reconstr Aesthetic Surg JPRAS 2014;67:634e9.

2. Hallock GG. The superior epigastric(RECTUS ABDOMINIS) muscleperforator flap. Ann Plastic Surg 2005;55:430e2.

3. Hamdi M, Van Landuyt K, Ulens S, et al. Clinical applications ofthe superior epigastric artery perforator (SEAP) flap: anatomicalstudies and preoperative perforator mapping with multidetectorCT. J Plastic Reconstr Aesthetic Surg JPRAS 2009;62:1127e34.

4. Schmidt M, Tinhofer I, Duscher D, Huemer GM. Perforasomes ofthe upper abdomen: an anatomical study. J Plastic ReconstrAesthetic Surg JPRAS 2014;67:42e7.

Ines TinhoferDivision of Plastic and Reconstructive Surgery, Department

of Surgery, Medical University Vienna, Vienna, Austria

Center for Anatomy and Cell Biology, Medical University ofVienna, Vienna, Austria

E-mail address: ines.tinhofer@meduniwien.ac.atManfred Schmidt

Section of Plastic and Reconstructive Surgery, Departmentof General Surgery, General Hospital Linz, Linz, Austria

Chieh-Han John TzouThomas Rath

Reinhard PauzenbergerDivision of Plastic and Reconstructive Surgery, Department

of Surgery, Medical University Vienna, Vienna, Austria

9 July 2014