ITADE flap after mastectomy for locally advanced breast cancer: A good choice for mid‐sized defects of the chest wall, based on a systematic review of thoracoabdominal flaps

Abstract

ITADE allows extensive coverage areas, an early start of adjuvant treatment and it can be performed without requiring a reconstructive team.

Reply: ITADE flap after mastectomy for locally advanced breast cancer: A good choice for mid‐sized defects of the chest wall based on a systematic review of thoracoabdominal flaps

“…We would like to make a clarification regarding the systematic review previously reported in your journal . The author of one of the articles raised a question about the fact that I did not consider their flap to be a fasciocutaneous flap but rather a dermofat flap.…”

“…In the presence of a subcutaneous pedicle, the tissue flap can be considered a Type A fasciocutaneous flap . Evaluating the published article and using the above classifications, I reviewed all the considered dermofat flaps described in ITADE’s article . Baroudi et al (1978) “reported that the “dissection is done at the level of the aponeurosis, from the end back to the base of the flap.” Tai et al (1974) reported that “it is wise to leave the deep fascia under the flap.” The flap described by Das and Choudhury (2013) was described using skin and subcutaneous tissue.…”

“…Burattini et al described the use of the deep fascia as essential for the viability of the flap, but they performed a modification to the flap as described by Davis et al Baroudi et al, Tai et al, and Davis et al reported flaps before 1986, ie, before any classifications. Using the classification system developed by Cormack‐Lamberty and Mathes‐Nahai, all the flaps described in the published article may be classified as fasciocutaneous flaps.…”

“…To avoid conflicting with the terminological definition of the current international anatomical terminology, it is recommended to not use the term fascia for the description of the thoracoabdominal lining sheets, as already explained . Using the anatomical classification and histological evaluation, the majority of the flaps used after mastectomy do not have fascia, including the flap that is described in ITADE's article; as such, they are dermofat flaps.…”

“…As we have different classifications used for the same condition and, after evaluating the data of the systematic revision, the differences in classifications will only change the conceptual considerations associated with fasciocutaneous flaps and dermofat flaps, which will change only the second result presented in figure 4A. When evaluating thoracoabdominal flaps used after mastectomies, we must take care in reporting the classification used.…”