It is with great interest that we have read the recent publication of Legemate CM et al. on the technique and long-term outcome of the pedicled internal pudendal artery perforator (PIPAP) flap for ischial pressure sore reconstruction.1 First described by Hashimoto et al., this flap is an interesting option due to its rich vascular network, easy dissection, feasible primary closure of the donor site, and the fact that the pudendal artery perforators are close to the location of the ischial defect.
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