We read the article by Spyropoulou et al, 1 ''Buried anterolateral thigh flap for pharyngoesophageal reconstruction: our method for monitoring,'' which describes a method used in 16 cases whereby a 3-cm stump of the descending branch of the lateral circumflex femoral artery is left beyond the origin of the perforator, and is brought out to the skin to be used as a visual monitor based on its pulsatility and color. The authors described 2 cases in which the stump stopped pulsing and the flap was explored: in 1 case the arterial anastomosis was occluded, and in the other case a hematoma was responsible for compressing the vein.
Monitoring a buried free flap can be problematic, and-as the authors point out-there are many different methods that have been described; thus a new method to add to the armamentarium is always welcome. We do have reservations about this method, however, because the deliberate fashioning of a relatively long blind stump will most likely encourage the formation of thrombi through a combination of turbulence and stasis. Although this has not been demonstrated clinically, it has been demonstrated in a mouse model after carotid artery ligation. 2 We would wonder whether the arterial anastomotic occlusion in the first case may be related to use of the stump itself.