LAUSR

Dear Editor, We read with great interest the commentary published by Du et al. to our latest article on the potential influence of Nacetylcysteine (NAC) on the autologous fat graft survivability [1, 2]. We are grateful for their interest in our study and made us realize that its methodology requires additional explanation. We agree with the suggestion that NAC might influence the fat graft harvested from the contralateral thigh (control). Thus, in our study protocol, infiltration with the tumescent fluid enriched with the NAC was always performed second, after the control graft harvest was completed. Such procedure sequence minimalized the potential influence of the systemic level of NAC on the control graft. This fact was not mentioned in our initial article, and we felt it needed clarification. It is also worth mentioning that the surgeon performing all the operations was blinded during the study to the types of the tumescent fluid used for infiltration of the donor site. Of course, we agree with the argument that some volume of the NAC given locally with the tumescent fluid was absorbed into the systemic circulation. However, it took place after the control graft was harvested; therefore, the systemic NAC did not influence it in any way. Its possible protective effect on the fat in the recipient site is, on the other hand, a subject for another study. Du et al. rightly emphasize the need for analysis of the NAC blood level after the local infiltration. In our previous study, which had a pilot study status, we did not perform it as we focused only on the NAC’s local effect. We are considering another study, this time with additional NAC given i.v. in the early postoperative period and with blood level monitoring, so its possible correlation with graft survivability can be evaluated. Once again, we would like to thank Du et al. for their valuable comments and for pointing out the lack of relevant information in the methodology description of our latest study.