LETTERS TO THE EDITOR Letter Regarding “Salvage of Complete Degloved Digits With Reversed Vascularized Pedicled Forearm Flap: A New Technique” To the Editor: We read Noaman’s article 1 with interest. We agree that degloving of digits remains a challenge in reconstructive surgery. When replantation is not possible, alternative techniques have been advo- cated for soft tissue coverage. Distal pedicle flaps taken from the groin or the abdomen have been used in the past, with poor results both aestheti- cally and functionally. In 1995, we published, 2 as did others, 3,4 articles on the use of a distally based radial forearm flap to treat degloved fingers. Despite the use of a radial forearm flap with its cutaneous nerve supply, there was little recovery of sensibility in the recon- structed finger, and the aesthetic results were al- ways unsatisfactory. In Noaman’s Figures 2 and 3, the reconstructed ring finger appears bulky. More- over, the mature donor site is highly visible. This is the frequent outcome when the forearm skin cannot be closed directly. We are impressed to hear of the recovery the sensibility obtained in 16 of the 26 patients to less than 10 mm of static 2-point discrimination. We believe that a radial fascial flap 5 provides thin, pliable, and vascularized tissue that allows for free gliding of tendons and easy mobilization of joints, with acceptable aesthetic results and, above all, a pleasing donor site result. We wonder why the author decided to salvage the nail during the operation, yet the final result shows the ring finger without the distal phalanx. We contend that the best treatment for ring deglov- ing injuries (when replantation is impossible) is ray amputation, but to satisfy insistent requests to salvage the ring finger, the best solution is to use fascial flaps. 5 Contrarily, a degloved thumb must always be sal- vaged. Today, the standardized procedure is to har- vest the wrap-around flap from the great toe to pro- vide a pleasing cosmetic result. Roberto Adani, MD Hand Surgery Department Azienda Ospedaliera Universitaria Integrata Verona Verona, Italy Luigi Tarallo, MD Department of Orthopaedic Surgery University of Modena and Reggio Emilia Modena, Italy http://dx.doi.org/10.1016/j.jhsa.2012.06.043 The authors of the article were invited to reply but did not respond. REFERENCES 1. Noaman HH. Salvage of complete degloved digits with reversed vascularized pedicled forearm flap: a new technique. J Hand Surg 2012;37A:832– 836. 2. Adani R, Castagnetti C, Landi A. Degloving injuries of the hand and fingers. Clin Orthop Relat Res 1995;314:19 –25. 3. Pshenisnov K, Minachenko V, Sidorov V, Hitrov A. The use of island and free flaps in crush avulsion and degloving hand injuries. J Hand Surg 1994;19A:1032–1037. 4. Jones NF, Jarrahy R, Kaufman MR. Pedicle and free radial forearm flaps for reconstruction of the elbow,wrist and hand. Plast Reconstr Surg 2008;121:887– 898. 5. Carty MJ, Taghinia A, Upton J. Fascial flap reconstruction of the hand: a single surgeon’s 30-year experience. Plast Reconstr Surg 2010;125;953–962. Letter Regarding “Effect of Platelet-Rich Plasma With Fibrin Matrix on Healing of Intrasynovial Flexor Tendons” To the Editor: I read with great interest the article by Sato et al. 1 This work addressed that platelet-rich plasma (PRP) improved tendon healing strength. I would like to complete the discussion of Lee and col- leagues by introducing a major complementary route by which platelet- rich plasma could reduce tendon re-rupture. ©  ASSH  Published by Elsevier, Inc. All rights reserved.  2197