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Letter to the editor
Answer to: “Re: Intramuscular lipomas: Large and deep benign lumps not to be underestimated. Review of a series of 51 cases”
Respuesta a «Re: Lipomas intramusculares: bultos grandes y profundos que no hay que menospreciar. Revisión de una serie de 51 casos»
L.R. Ramos-Pascua
Servicio de Cirugía Ortopédica y Traumatología, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), León, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In relation to the points highlighted by Dr&#46; Ivan Chernev regarding our work&#44; firstly we would like to thank him for their relevance&#46; As we mentioned in the beginning of the Discussion&#44; &#8220;benign lipomatous tumors encompass a wide and complex variety of lesions&#8221;&#46; Having said this&#44; the term &#8220;deep-seated lipoma&#8221; is indeed more suitable and less &#8220;controversial&#8221; to refer to a pathology which is not perfectly defined and which probably includes other entities in addition to intra- and intermuscular lipomas&#44; like hibernomas and others&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In our series&#44; in the Results section&#44; we describe 78&#37; of the intramuscular lipomas and 20&#37; of the intermuscular lipomas based on MRI findings&#44; since in our hands they were both clinically and histopathologically undistinguishable&#46; In any case&#44; distinction through imaging is not simple&#44; given that&#44; in the same patient&#44; a tumor may appear&#44; or be&#44; intramuscular in one section and intermuscular in another&#46; Since the approach was fundamentally clinical and general&#44; in the second paragraph of the Discussion we pointed out that we would be using the term &#8220;intramuscular lipoma&#8221; to refer to entities including tumors in deep locations with respect to the fascia&#44; established within a muscle or between muscle groups&#46; The precision of distinguishing and analyzing them separately&#44; as done by Fletcher and Martin Bates in 1988<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and previously by Kindblom et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> is very accurate&#44; although this was not the objective of our study&#46; In fact&#44; in the section on the limitations of the study&#44; we insist on the decision to group them all under the term &#8220;intramuscular lipoma&#8221;&#46; The proportion between males and females in our series was indeed close to 3&#47;1&#46; Although we did not specify it&#44; after reviewing this information based on the comments received&#44; the proportion was even greater in favor of males in the group of intramuscular lipomas&#46; Additionally&#44; and supporting the epidemiological data&#44; since the publication of the article we have intervened 4 new patients with deep-seated lipomas&#58; 1 female &#40;an intermuscular lipoma&#41; and 3 males &#40;3 intramuscular lipomas&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We completely agree with the third and fourth observations&#46; Regarding the reference to recurrences&#44; the low incidence in our series should be interpreted with natural caution due to the limitation of a mean follow-up of 33 months&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Lastly&#44; we agree on the importance of adding to the conclusion of our work the convenience of distinguishing the different types of deep-seated lipomas&#44; as well as the need to continue extending the knowledge about this pathology&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Level of evidence</span><p id="par0025" class="elsevierStylePara elsevierViewall">Level of evidence V&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ramos-Pascua LR&#46; Respuesta a &#171;Re&#58; Lipomas intramusculares&#58; bultos grandes y profundos que no hay que menospreciar&#46; Revisi&#243;n de una serie de 51 casos&#187;&#46; Rev Esp Cir Ortop Traumatol&#46; 2014&#59;58&#58;254&#8211;255&#46;</p>"
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ISSN: 19888856
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