Utilização do músculo sóleo para perdas musculocutâneas de terço médio da perna

Abstract

211Utilização do músculo sóleo para perdas musculocutâneas de terço médio da perna Utilização do músculo sóleo para perdas musculocutâneas de terço médio da pernaThe use of soleus muscle flap in musculocutaneus losses of the middle third of lower leg RESUMO Introdução: Áreas lesionadas de membros inferiores são portas abertas à infecção, às perdas de plasma, sangue, eletrólitos e líquidos, além de serem responsáveis por dor intensa. Por isso, é necessário cobri-las o mais rapidamente possível, para que o paciente se estabilize precocemente, prevenindo complicações e futuras sequelas. Os retalhos musculares e musculocutâneos são opções de reparo cirúrgico destas áreas. Ao longo dos anos, sugeriram vários tratamentos com retalhos para reparações de lesões, dentre eles o retalho do músculo sóleo, foco deste trabalho. Objetivo: Relatar a experiência do autor empregando a rotação do músculo sóleo. Método: Foram tratados cirurgicamente 18 pacientes com perda de substância no terço medial da perna, utilizando a rotação do músculo sóleo, no período de 2008 a 2010. Resultados: Os resultados obtidos foram satisfatórios e sem complicações maiores. Conclusão: Este procedimento é um recurso para o tratamento de lesões decorrentes de diferentes etiologias, como úlceras, osteomielite, perda de substância cutânea de terço médio da perna e cobertura cutânea em lesões com exposição de estruturas osteotendinosas, tornando-se uma ferramenta de grande auxílio ao cirurgião plástico.Descritores: Músculo Esquelético. Extremidade Inferior. Retalhos Cirúrgicos. Procedimentos cirúrgicos reconstrutivos. ABSTRACT Introduction:Lower limb damaged areas are open doors to infection, to the loss of plasma, blood, electrolytes and fluids, in addition to being responsible for intense pain. Therefore it is necessary to cover them as soon as possible so that the patient can be stabilized preventing early complications and future sequels. Muscle and musculocutaneous flaps are used to repair these areas. Over the years several treatments with flaps have been suggested for injuries repairment, among them the soleus muscle flap, the focus of this work. Objective: To describe the author's experience using the rotation of the soleus muscle. Methods: Eighteen patients with loss of substance of the medial third of the leg were treated by using the rotation of the soleus muscle, from 2008 to 2010. Results: The results were satisfactory and without major complications. Conclusion: This is an option to treat lesions caused by various etiologies such as ulcers, osteomyelitis, loss of cutaneous substance of third middle leg, and to cover skin lesions with exposure of osteotendinous structures, becoming a great assistance tool to the plastic surgeon.

Use of local muscle flaps to cover leg bone exposures

“…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. They thus offer a good option for bone and soft tissue coverage of the Table 1 Table 1 Table 1 Table 1 Table 1 proximal and middle thirds of the leg, being the most used, usually individually [8][9][10][11][12][13][14][15][16] . In some situations, one may employ the soleus associated with one of the belies of the gastrocnemius 17 .…”

Soleus Muscle Flap Application for Reconstruction of the Middle Third of the Leg

“…Lower limbs have some particularities that hinder the treatment, as skin with poor elasticity, little subcutaneous tissue and terminal arterial vascularization, besides the difficulty in venous return by the orthostatic position [9,10]. Due to these anatomical characteristics, the decision about the best technique depends on some factors as the location of the defect in the leg, injury extension, viability of tissues, circulatory conditions, and patient general conditions, besides the surgeon experience with reconstruction techniques [2,14,15].…”

“…In order to cover lower limb substance losses, the leg is divided in thirds (proximal, middle and distal) [2,10]. For the proximal third of the tibia, the gastrocnemius muscle flap is the best choice.…”

Bases anatômicas para utilização do músculo fibular terceiro em retalhos miocutâneos

“…Injuries of the leg and dorsal foot associated with soft tissue loss are common in emergency rooms 1 . Plastic surgeons use a range of surgical approaches to treat these lesions to ensure sufficient coverage and preservation of the structure, and to avoid complications and long hospital stays, especially in small or medium urban centers with a lack of skilled surgeons or the infrastructure for conducting microsurgery 2 .…”

“…For moving tissue from the donor site to the grafting site, the following should be considered: distance between the donor site and the injured site, size of the flap available for the transplant conditions of the implant area, and presence of an adequate supply of tissue 1,46 . The ideal flap yields the best esthetic and functional results with minimal sequelae 1,4 .…”