Retalho sural de fluxo reverso: 10 anos de experiência clínica e modificações

Abstract

Reverse flow sural flap: 10 years of clinical experience and changes Reverse-flow sural flap: 10 years of clinical experience and modifications Retalho sural de fluxo reverso: 10 anos de experiência clínica e modificações ABSTRACT Background: The reverse flow sural flap has been featured as a relevant option for reconstruction of the distal region of the legs and feet. However, some common mistakes are made while surgeons are learning how to employ this flap. The aim of this study was to analyze use of the flap by surgeons in with 10 years of experience by comparing the first 5 years to the last 5 years in order to identify technical alterations that contribute to better results. This study also aimed at alerting the surgeons in the learning phase regarding the most important details that should be addressed when using this technique. Methods: We studied the results obtained for 61 reverse flow sural flaps used from January 2002 to December 2011. The patients were divided into 2 groups: group 1, patients that underwent surgery from January 2002 to December 2006 and group 2, patients that underwent surgery from January 2007 to December 2011. In group 2, we made changes to the fasciocutaneous flaps that included dissection of a fasciosubcutaneous margin exceeding the cutaneous portion of the flap and preservation of a lane of skin over the pedicle. Results: In group 1, the incidences of partial necrosis and total necrosis were 18.5% and 3.7%, respectively, whereas group 2 had an 8.8% incidence of partial necrosis and no cases of total necrosis. Conclusions: The reverse flow sural flap is a good option for the treatment of the distal region of the legs and feet. Experience with this technique and the additional cautions described herein may contribute to even better results.

Reconstrução de membro inferior – retalho fasciocutâneo sural

“…Studies performed > 10 years ago showed a higher rate of complications (≤ 35%), with a significant reduction during the last 10 years (≤ 12%). 6 10 11 12 This fact was also reported by Vendramin et al, 13 who found different complication rates after evaluating the outcomes from the same surgical team at different periods of the learning curve. These literature findings do not agree with the present study, whose success rate was of 87.5%, since complications did not have any relation with the learning curve, as this technique was introduced in this service in 2001 and the complications occurred in 2009, 2013 and 2015.…”

Use of local muscle flaps to cover leg bone exposures

“…The fasciocutaneous or fascial flaps of distal pedicle can be a good alternative to the distal regions, although this requires a good local circulation [2][3][4] . The microsurgical free flap has become a frequent indication.…”

Squamous cell carcinoma developed on neglected, mistreated and delayed diagnosed chronic venous leg ulcer

“…The use of skin grafts in these lesions is hampered by the scarce vascular bed and the poor granulation of wounds, often associated with prolonged exposure of deep structures, such as bone, tendon and blood vessel, and may be exacerbated by infections, as osteomyelitis [18]. There are many pedicled laps for soft tissue reconstruction in lower extremities (local fasciocutaneous laps, the sural lap or reverse sural lap, the gastrocnemius lap, the saphenous fasciocutaneous lap, the soleus or hemisoleus lap, the lateral supramalleolar lap, the perforator-based propeller lap) but the selection of the the laps depends on the avaibility of the donor sites, which are mainly located around the injured area [19][20][21][22][23][24][25][26][27]. Nowadays free-lap is the choice method to cover soft tissue defects in the distal third of the leg, but it has major disadvantages [28,29].…”