LAUSR

Dear Editor, We read with interest the article by Miyamoto, Arikawa, and Kagaya regarding the use of lower abdominal perforator flaps in reconstruction after sarcoma resection (Miyamoto, Arikawa, & Kagaya, 2020). First of all, we would like to congratulate the authors for the good outcomes achieved in their series. We totally agree with the authors that despite the free deep inferior epigastric artery perforator (DIEP) flap is the first choice in autologous breast reconstruction, pedicled DIEP for the lower limb has received less attention. In their case series, the authors have harvested only oblique pedicled DIEP for thigh reconstruction. However, despite the few data in the current literature, pedicled DIEP flap for groin and upper third of the thigh reconstruction has been described not only in an oblique fashion, but also transverse and vertical (Zeng, Xu, Yan, You, & Yang, 2006). The authors stated that if an obliteration of the dead space is required, they converted the pedicled DIEP to a rectus abdominis musculocutaneous flap. However, to fill dead spaces, a pedicled split extended vertical deep inferior epigastric has been described also with a sarcoma resection resulted in a deep defect with exposed vessels in the proximal third of the thigh, when multilayered reconstruction is required (Scaglioni, Giunta, Barth, & Giovanoli, 2020). Otherwise, in those cases, not requiring extra bulking and with no exposure of vital