We read with great interest the case report from Bellerini et al. titled: “Intraoperative Evidence of Early Neovascularization in a SCIP Flap Following Postoperative Trauma: A Case Report” (Ballerini et al. 2025), which falls within our field of interest. The authors describe an early autonomization (POD19) of a fasciocutaneous free flap to cover tibial bone exposure with the identification of a neo-perforator vessel. First, we wish to congratulate the authors on this case, showing the great performance of SCIP flap-based reconstructions in orthoplastic cases. In patients with complex histories (radiation, bone graft failure), we suggest the alternative of chimeric osteocutaneous SCIP flaps to ensure the survival of the bone component (Berkane et al. 2025). Second, the demonstration of neo-perforator vessels participating in the neovascularization of a free flap is of crucial significance. While we reviewed the current evidence of early autonomization of fasciocutaneous flaps, demonstrating substantially lower neovascularization delays than what is commonly admitted (with early evidence of flap survival following pedicle division as early as POD7) (Berkane et al. 2023), the current evidence of the neovascularization mechanisms is feeble. Theories include pre-existing capillary networks revascularization and VEGF-mediated neo-vascularization, but major neovascularization from perforator vessels remains novel to our knowledge. We wish to support the authors' findings by sharing a recent case of a secondary abdominoplasty procedure to address a major and recurrent seroma, where neo-perforators, probably emerging from the left deep inferior epigastric network, were identified to penetrate the abdominal flap that was undermined from the supraumbilical area, at the level of the inferior abdominal scar (Figure 1). The revision procedure happened 5 months after the primary surgery (free DIEP flap reconstruction using the right epigastric network). The authors' work, therefore, supports the possibility of early neo-perforator formation, which should be further explored. The advances of imaging, including ICG angiography and microflow ultrasound probes (Goudot et al. 2022), could help understand the kinetics and balance of flap neovascularization and remaining dependence on the original pedicle, which probably explains the contradictory findings discussed by the authors. The authors have nothing to report. All work was conducted accordingly with the French Bioethics laws and the Declaration of Helsinki. Consent was obtained for all patient-derived data. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
Berkane et al. (Thu,) studied this question.