Complications of prolonged prone positioning during reconstructive surgery

[Extract] Dear Editor, We enjoyed the article from Flores et al. "Bilateral simultaneous breast reconstruction with SGAP flaps" published in Microsurgery in March 2012, 1 in which a study demonstrated the use of bilateral superior gluteal artery perforator (SGAP) flaps as a viable option for bilateral breast reconstruction. In particular, the authors undertook bilateral reconstruction with the use of two surgical teams, simultaneously harvesting the SGAP flaps whilst the patient was in prone position. We would like to comment on the importance of this point of using two teams for flap harvest in order to minimize time spent with the patient in prone position. Multiple complications have been associated with surgery in the prone position including increased risk for postoperative visual loss, abdominal compartment syndrome, and venous thrombosis, and although not well reported in the literature, 2–6 this article offers the opportunity to discuss the evidence for this