Plastic and Reconstructive Surgery December 2011

Danielle R. Zurovcik, M.S.

Massachusetts Institute of Technology Cambridge, Mass.

Gita N. Mody, M.D.

Brigham and Womens Hospital Boston, Mass. Correspondence to Dr. Orgill Division of Plastic Surgery Brigham and Womens Hospital 75 Francis Street Boston, Mass. 02115 dorgill@partners.org

DISCLOSURE Dr. Orgill has been an investigator on a grant to Brigham and Womens Hospital from Kinetic Concepts, Inc., and served as an expert witness and consultant for Kinetic Concepts, Inc. Ms. Zurovcik is an inventor of the device described in this communication. Dr. Mody has no conflicts of interest to disclose. REFERENCES
1. Argenta LC, Morykwas MJ. Vacuum-assisted closure: A new method for wound control and treatment. Clinical experience. Ann Plast Surg. 1997;38:563576; discussion 577. 2. Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP. Vacuum-assisted closure: Microdeformations of wounds and cell proliferation. Plast Reconstr Surg. 2004;114:10861096; discussion 10971098. 3. U.S. Food and Drug Administration. FDA Safety Communication: UPDATE on Serious Complications Associated with Negative Pressure Wound Therapy Systems, Issued February 24, 2011. Available at: http://www.fda.gov/MedicalDevices/ Safety/AlertsandNotices/ucm244211.htm. Accessed June 1, 2011.

the arteries measured are at least one-third less than those in fresh cadavers. There is a report that the differences in dimensions of the coronary artery between the histologic sections and the fresh tissues in the no-load state were small for the inner and outer diameters (5.6 and 5.2 percent, respectively).5 I think that the authors did not consider this report. I think that it might be attributable to a selection bias if they excluded the pedicles with diameters less than 1.8 mm or greater than 1.2 to 1.3 mm. If they would include these vessels as major pedicles, they could not suggest reconsideration of the sartorius muscle vascular supply as a subtype of III or IV having a segmental vascularization with two more robust pedicles. I believe injecting pedicles that are smaller than 1.8 mm in diameter could perfuse the overlying skin as effectively as 1.8-mm-diameter pedicles. In addition, I would like to know why the methylene bluestained area in Figure 10 is much larger (13.4 26.7 cm) than the perfusion area on static computed tomographic angiography (9.3 16.9 cm) (Fig. 14).1 I also want to know how long the authors waited to measure the staining area after the methylene blue injection.
DOI: 10.1097/PRS.0b013e318230c153

Kun Hwang, M.D., Ph.D.

Department of Plastic Surgery and Center for Advanced Medical Education by BK21 Project Inha University School of Medicine 7-206 Sinheung-dong, Jung-gu Incheon 400-711, Republic of Korea jokerhg@inha.ac.kr

REFERENCES
1. Mojallal A, Wong C, Shipkow C, et al. Redefining the vascular anatomy and clinical applications of the sartorius muscle and myocutaneous flap. Plast Reconstr Surg. 2011;127:19461957. 2. Mathes SJ, Nahai F. Muscle flap transposition with function preservation: Technical and clinical considerations. Plast Reconstr Surg. 1980;66:242249. 3. Mathes SJ, Nahai F. Classification of the vascular anatomy of muscles: Experimental and clinical correlation. Plast Reconstr Surg. 1981;67:177187. 4. Buckland A, Pan WR, Dhar S, et al. Neurovascular anatomy of sartorius muscle flaps: Implications for local transposition and facial reanimation. Plast Reconstr Surg. 2009;12:4454. 5. Choy JS, Mathieu-Costello O, Kassab GS. The effect of fixation and histological preparation on coronary artery dimensions. Ann Biomed Eng. 2005;33:10271033.

Major Pedicles of the Sartorius Muscle

Sir: he following comments pertain to Redefining the Vascular Anatomy and Clinical Applications of the Sartorius Muscle and Myocutaneous Flap by Mojallal et al.1 According to the classification of Mathes and Nahai, the sartorius muscle is considered to have a type IV segmental vascular supply.2,3 In this article, the authors suggested that the sartorius muscle vascular supply should be reconsidered as a subtype of III or IV, having a segmental vascularization, with two more robust pedicles. The basis for this opinion is that one major pedicle with a diameter greater than 1.8 mm could supply at least 80 percent of the sartorius muscle.1 However, Buckland et al.,4 in a previous study, reported a mean diameter of the major pedicles of 1.1 and 1.2 mm, which are less than the diameters in the study by Mojallal et al.1,3 Mojallal et al. stated that this discrepancy can be explained by the fact that Buckland et al. used embalmed cadavers also (38 embalmed and 17 fresh cadavers).1,3 This means that Mojallal et al. believe that, in embalmed cadavers, the diameters of

Reply: Major Pedicles of the Sartorius Muscle

Sir: We would like to thank Dr. Hwang for his interest and comments regarding our article, Redefining the Vascular Anatomy and Clinical Applications of the Sartorius Muscle and Myocutaneous Flap. In our study, we have proposed a redefinition of the vascular territory of the major pedicles of the sartorius muscle and the musculocutaneous flap based on an anatomical and

786e