I want to thank Dr. Park for his comments. Certainly other options exist in the management of keloids, but in this setting of a chronically infected keloid that had already had multiple procedures done by other physicians we felt free tissue might have some certain advantages. As Dr. Park had mentioned this patient’s primary complaint was pain and tightness in the area of the chronically infected keloid. We did not feel that a skin graft would be ideal due to some of the known inherent limitations of skin grafting (contracture and susceptibility to infection). Local flaps were also considered but we didn’t want to put any tension in the area of concern or make other incisions in the neck that would potentially worsen the patient’s symptoms. Certainly as in all aspects of reconstructive surgery the reconstructive ladder should be considered and the simplest most effective method of reconstruction should be employed. In this case with the patient’s prior procedures, chronic infection, close proximity to sternal wires and symptoms/findings of contracture we felt free tissue transfer offered enough benefits to warrant its use.