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• Reply to Response to the article " Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique": Not a Novel Technique
  Devendra Kumar Gupta, Rajeev Chugh
  Published on: 7 October 2020
• Response to the article " Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique": Not a Novel Technique
  Mohhammed Alam Parwaz, Pallab Chatterjee
  Published on: 8 September 2020

• Published on: 7 October 2020

  Reply to Response to the article " Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique": Not a Novel Technique

  • Devendra Kumar Gupta, Head Neck Oncosurgeon Army Hospital R & R, New Delhi
  • Other Contributors:
    • Rajeev Chugh, Head Neck Oncosurgeon

  We read the response to our case report published in BMJ case reports " Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique"[1]
  We would like to clarify that there is a difference between a new flap and a new technique. A new flap is the one described for the first time in the literature. Contrary to that in a novel technique either a previously described flap or a new flap is used for an indication which has no mention in the literature. Pedicled islanded nasolabial flap have been used in a number of ways and the the cited references by Dr M Alam et al are about its use for floor of mouth reconstruction or for cervical oesophagus for stricture correction. We have also published one such series recently for its versatile use in head neck reconstruction. [2]

  To the best of our knowledge it has not been used for a neopharyngeal reconstruction following total laryngectomy and partial pharyngectomy and hence titled as the Novel Technique of neopharyngeal reconstruction.

  We refute the statement made by Alam et al in there comment " 5. It is submitted that the rightful credit and recognition belongs to the authors who described the islanded skin flap based on facial vessels in the 1980s. It is not a novel flap christened as DK Gupta flap." and reiterate again that " Use of the facial artery-based cutaneous island flap (mel...

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  We read the response to our case report published in BMJ case reports " Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique"[1]
  We would like to clarify that there is a difference between a new flap and a new technique. A new flap is the one described for the first time in the literature. Contrary to that in a novel technique either a previously described flap or a new flap is used for an indication which has no mention in the literature. Pedicled islanded nasolabial flap have been used in a number of ways and the the cited references by Dr M Alam et al are about its use for floor of mouth reconstruction or for cervical oesophagus for stricture correction. We have also published one such series recently for its versatile use in head neck reconstruction. [2]

  To the best of our knowledge it has not been used for a neopharyngeal reconstruction following total laryngectomy and partial pharyngectomy and hence titled as the Novel Technique of neopharyngeal reconstruction.

  We refute the statement made by Alam et al in there comment " 5. It is submitted that the rightful credit and recognition belongs to the authors who described the islanded skin flap based on facial vessels in the 1980s. It is not a novel flap christened as DK Gupta flap." and reiterate again that " Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: is a novel technique"

  References :

  1. Gupta DK, Chugh R, Singh SK, Pati S. Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique. BMJ Case Rep. 2019;12(8):e230712.

  2. Chakrabarti, S., Gupta, D.K., Gupta, M., Daga, D., Mishra, A., Sharma, S.S., Chugh, R. and Singh, S.K. (2020), Versatility and Reliability of Islanded Pedicled Nasolabial Flap in Head and Neck Cancer Reconstruction. The Laryngoscope, 130: 1967-1972. doi:10.1002/lary.28662

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  Conflict of Interest:
  None declared.

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• Published on: 8 September 2020

  Response to the article " Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique": Not a Novel Technique

  • Mohhammed Alam Parwaz, Plastic Surgeon Army Hospital (R&R), Delhi Cantt., New Delhi – 110010 (India)
  • Other Contributors:
    • Pallab Chatterjee, Plastic Surgeon

  1. We read with interest the article “Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique in your journal [1]. The authors, Gupta et al, have described the use of islanded melolabial flap for reconstruction of neopharynx after total laryngectomy. In the article, the islanded melolabial flap is presented as a novel, christened as DK Gupta flap, that compares favorably to other loco-regional and free flaps for similar reconstructions.
  2. The authors need to be commended for a well written article with clear descriptive photographs and the good clinical results obtained. However, an islanded one-stage arterialized nasolabial flap was described in 1981 by Rose [2] for the repair of the floor of mouth defect. The elliptical skin flap over the nasolabial crease was elevated between the skin and the level of buccinator, completely islanded and isolated on skeletonised facial artery and vein, exactly in the same manner as described by Gupta et al [1] in their article. The same flap, the islanded facial artery flap, with the same description of elevation was again described by Piggot in 1987 [3] in which the flap was introduced deep to the mandible for the repair of floor of the mouth defect. Even full thickness through and through islanded arterialized flap based on facial vessels that incorporates the buccal mucosa was described by Sasaki et al in 1980s for reconstructi...

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  1. We read with interest the article “Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique in your journal [1]. The authors, Gupta et al, have described the use of islanded melolabial flap for reconstruction of neopharynx after total laryngectomy. In the article, the islanded melolabial flap is presented as a novel, christened as DK Gupta flap, that compares favorably to other loco-regional and free flaps for similar reconstructions.
  2. The authors need to be commended for a well written article with clear descriptive photographs and the good clinical results obtained. However, an islanded one-stage arterialized nasolabial flap was described in 1981 by Rose [2] for the repair of the floor of mouth defect. The elliptical skin flap over the nasolabial crease was elevated between the skin and the level of buccinator, completely islanded and isolated on skeletonised facial artery and vein, exactly in the same manner as described by Gupta et al [1] in their article. The same flap, the islanded facial artery flap, with the same description of elevation was again described by Piggot in 1987 [3] in which the flap was introduced deep to the mandible for the repair of floor of the mouth defect. Even full thickness through and through islanded arterialized flap based on facial vessels that incorporates the buccal mucosa was described by Sasaki et al in 1980s for reconstruction of oesophageal strictures and limited defects of upper aerodigestive tract [4, 5].
  3. An inadvertent oversight in the review of literature might have caused the authors to not include the references of these seminal papers in their article.
  4. This option of using skin from face as islanded flap could never become a popular reconstructive option despite being there in the armamentarium for over four decades due to inherent reluctance to use facial skin as donor for non face areas, high risk of injury to marginal mandibular nerve, loss of lower buccal facial nerve branches and a possible compromise on obtaining nodal clearance to preserve facial vessels.
  5. It is submitted that the rightful credit and recognition belongs to the authors who described the islanded skin flap based on facial vessels in the 1980s. It is not a novel flap christened as DK Gupta flap.

  References
  1. Gupta DK, Chugh R, Singh SK, Pati S. Use of the facial artery-based cutaneous island flap (melo-labial flap) for reconstruction of the neopharynx following total laryngectomy: a novel technique. BMJ Case Rep. 2019;12(8):e230712.
  2. Rose EH. One-stage arterialized nasolabial island flap for floor of mouth reconstruction. Ann Plast Surg. 1981;6(1):71-75.
  3. Piggot TA, Logan AM, Knight SL, Milner RH. The facial artery island flap. Ann Plast Surg. 1987;19(3):260-265.
  4. Sasaki TM, Taylor L, Martin L, Baker HW, McConnell DB, Vetto RM. Correction of cervical esophageal stricture using an axial island cheek flap. Head Neck Surg. 1983;6(1):596-599.
  5. Sasaki TM, Standage BA, Baker HW, McConnell DB, Vetto RM. The island cheek flap: repair of cervical esophageal stricture and new extended indications. Am J Surg. 1984;147(5):650-653.

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  Conflict of Interest:
  None declared.

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