LAUSR

We read with interest the recent review of reconstructive options in upper limb circumferential defects “Soft tissue reconstruction of complete circumferential defects of the upper extremity”, by Ng et al. [1] published in May 2017. It is clear from the dearth of reported cases in the literature that this is a relatively rare, and severe, defect pattern with no clear consensus on the best method of reconstruction. The authors describe a number of grading systems of these injuries, including that by Tajima [2], which describes the depth of injury in relation to structures affected. The authors suggest a treatment algorithm for reconstruction of such defects based on aetiology. The authors correctly point out that in addition to size, choice of reconstruction must take into account volume, mobility, and pliability to maximise functional outcome [3]. LETTER