Surgical choices versus optimal patient benefit

To the Editor:

Drs Chung and Tong (J Hand Surg 2001;26A:956–961) showed superior technical skills in their use of 3 free flaps on a single vascular pedicle to reconstruct a burned hand of a 12-year-old girl. They achieved the hand repair, however, at the cost of permanent disfigurement to a foot and scarring at an unreported skin graft site. The child was quite conscious of the appearance of the foot after surgery.

The science of hand surgery advances—appropriately so—but I am concerned about the loss of