Cobertura do terço distal da perna com retalhos de perfurantes pediculados

Abstract

Os retalhos de vasos perfurantes representam um avanço no tratamento das perdas cutâneas. No terço distal da perna as opções para a cobertura cutânea são poucas e muitas vezes devemos recorrer a microcirurgia. Neste trabalho realizou-se uma avaliação prospectiva de 20 pacientes submetidos ao tratamento de áreas cruentas no terço distal da perna através de retalhos pediculados em artéria perfurante. A localização das artéria perfurantes foi feita , no pré-operatório , através do exame de eco-doppler. Os retalhos foram planejados de forma a permitir sua rotação junto à área cruenta em até 180 graus. Em 6 casos os vasos perfurantes tinham como origem a artéria fibular, em 10 a artéria tibial posterior e 4 a artéria tibial anterior. O índice de acerto do eco-doppler foi de 88,2%. Em pacientes jovens com lesões traumáticas houve 15,4% de falha do procedimento e 33,3% em pacientes com morbidades associadas. Baseado em nossos resultados concluímos ser o retalho de perfurante uma boa opção de tratamento das perdas cutâneas no segmento distal da perna.

Use of local muscle flaps to cover leg bone exposures

“…However, microsurgical techniques require specialized training and in most hospitals there are no specialists available to carry them out. In addition, such patients usually require additional operations to [5][6][7] . The gastrocnemius and soleus muscles, being vascularized predominantly in their proximal regions, allow the rotation about the axis of the pedicle (good arc of rotation), without compromising vitality.…”

Utilização de retalho em hélice para cobertura de lesões de partes moles em membro inferior*

“…5 When assessing the profile of individuals involved in motorcycle accidents in the city of São Paulo, Brazil, Debieux et al 15 observed that most injuries occurred in the lower limbs (53.9%), and more frequently in the age group between 21 and 24 years (45%). Rezende et al, 9 when evaluating the epidemiological profile, surgical treatment and postoperative results of patients with complex traumatic injuries to the lower limbs, observed that the motorcycle accident was responsible for the majority of the injuries (37.8%), and that the lower third of the leg was the region most affected by trauma (50.4%), followed by the medial third (32%).…”

“…The factors involved in choosing the most appropriate surgical technique include the location, the extent of the lesion, the exposure of noble structures, and the surgeon's experience with reconstruction techniques. 9 The use of the propeller flap to cover lesions is an option when the area to be treated is small to medium in size, located in a well-vascularized region, and surrounded by healthy tissues. In this technique, we should consider the quality and volume of the transferred soft tissue, the orientation of the scar and the adequate planning of the flap, to enable the direct closure of the donor site without tension in the area.…”

Coverage of the lower third of the limb and foot injuries using reverse sural fasciocutaneous flap described by Carriquiry

“…In this segment, there is no interposition of the muscular tissues between the noble structures and integument; thus, it has limited distensibility and mobility. Therefore, the use of skin grafts and random rotation flaps is inadequate for wounds that affect the full thickness of the skin 10 . In these cases, it is necessary to use distant flaps, which can be fasciocutaneous or free 11 .…”