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DOI: 10.1055/s-0041-1735832
Fixador externo tipo delta no manejo pós-operatório de retalhos microcirúrgicos no membro inferior: Experiência de um hospital terciário[*]
Artikel in mehreren Sprachen: português | English
Resumo
Objetivo Avaliar o uso de fixadores externos, na configuração kickstand do tipo delta, como método adjuvante no período pós-operatório de pacientes submetidos a retalhos livres nos membros inferiores.
Métodos Ao todo, 17 fixadores externos do tipo delta foram utilizados em pacientes submetidos a retalhos livres nos membros inferiores. A técnica cirúrgica foi realizada de forma padronizada, com o pino distal localizado 6 cm proximal à anastomose, e o pino proximal, 6cm distal à tuberosidade anterior da tíbia.
Resultados A idade média da amostra foi de 34,76 anos (variação: 15 a 66 anos). Foram selecionados 11 homens e 6 mulheres. Utilizou-se a artéria tibial posterior em 14 casos, e a tibial anterior, em 3 casos. O tempo médio de uso dos fixadores externos foi de 3,88 semanas. A taxa de reoperação foi de 17,64%; a de perda do retalho foi de 11,76%; a de sucesso foi de 88,23%; e a taxa de infecção foi de 5,9%.
Conclusão O uso de fixadores do tipo delta como método adjuvante no pós-operatório é confiável; porém, mais estudos são necessários para avaliar seu verdadeiro papel no pós-operatório.
* Trabalho realizado no Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
Publikationsverlauf
Eingereicht: 29. Dezember 2020
Angenommen: 07. April 2021
Artikel online veröffentlicht:
25. Oktober 2021
© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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Referências
- 1 Wei F, Al Deek NF, Lin Tay SK. Principals and techniques of microvascular surgery. In: Plastic Surgery: Principles. Philadelphia: Elsevier; 2018: 444-472
- 2 Ninkovic M, Voigt S, Dornseifer U, Lorenz S, Ninkovic M. Microsurgical advances in extremity salvage. Clin Plast Surg 2012; 39 (04) 491-505
- 3 Benacquista T, Kasabian AK, Karp NS. The fate of lower extremities with failed free flaps. Plast Reconstr Surg 1996; 98 (05) 834-840
- 4 Perrot P, Bouffaut AL, Perret C, Connault J, Duteille F. Risk factors and therapeutic strategy after failure of free flap coverage for lower-limb defects. J Reconstr Microsurg 2011; 27 (03) 157-162
- 5 Xiong L, Gazyakan E, Kremer T. et al. Free flaps for reconstruction of soft tissue defects in lower extremity: A meta-analysis on microsurgical outcome and safety. Microsurgery 2016; 36 (06) 511-524
- 6 Zgonis T, Roukis TS. Off-loading large posterior heel defects after sural artery soft-tissue flap coverage with stacked taylor spatial frame foot plate system. Oper Tech Orthop 2006; 16 (01) 32-37
- 7 Nappi JF, Drabyn GA. External fixation for pedicle-flap immobilization: a new method providing limited motion. Plast Reconstr Surg 1983; 72 (02) 243-245
- 8 Zgonis T, Stapleton JJ. Innovative techniques in preventing and salvaging neurovascular pedicle flaps in reconstructive foot and ankle surgery. Foot Ankle Spec 2008; 1 (02) 97-104
- 9 Buford GA, Trzeciak MA. A novel method for lower-extremity immobilization after free-flap reconstruction of posterior heel defects. Plast Reconstr Surg 2003; 111 (02) 821-824
- 10 Castro-Aragon OE, Rapley JH, Trevino SG. The use of a kickstand modification for the prevention of heel decubitus ulcers in trauma patients with lower extremity external fixation. J Orthop Trauma 2009; 23 (02) 145-147
- 11 Kachare SD, Vivace BJ, Henderson JT. et al. Kickstand External Fixator for Immobilization Following Free Flap Plantar Calcaneal Reconstruction. Eplasty 2019; 19: e11
- 12 Berkowitz MJ, Kim DH. Using an external fixation “kickstand” to prevent soft-tissue complications and facilitate wound management in traumatized extremities. Am J Orthop 2008; 37 (03) 162-164
- 13 Roukis TS, Landsman AS, Weinberg SA, Leone E. Use of a hybrid “kickstand” external fixator for pressure relief after soft-tissue reconstruction of heel defects. J Foot Ankle Surg 2003; 42 (04) 240-243
- 14 Hirigoyen MB, Urken ML, Weinberg H. Free flap monitoring: a review of current practice. Microsurgery 1995; 16 (11) 723-726 , discussion 727
- 15 Baumeister SP, Spierer R, Erdmann D, Sweis R, Levin LS, Germann GK. A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. Plast Reconstr Surg 2003; 112 (01) 129-140 , discussion 141–142
- 16 Bhatnagar A. Miniwatermattress to prevent pressure sores over the heel. Plast Reconstr Surg 1997; 99 (03) 927-928
- 17 Yilmaz M, Karatas O, Barutcu A. The distally based superficial sural artery island flap: clinical experiences and modifications. Plast Reconstr Surg 1998; 102 (07) 2358-2367
- 18 Clark J, Mills JL, Armstrong DG. A method of external fixation to offload and protect the foot following reconstruction in high-risk patients: the SALSAstand. Eplasty 2009; 9: e21
- 19 Singh B, Cordeiro PG, Santamaria E, Shaha AR, Pfister DG, Shah JP. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg 1999; 103 (02) 403-411
- 20 Noack N, Hartmann B, Küntscher MV. Measures to prevent complications of distally based neurovascular sural flaps. Ann Plast Surg 2006; 57 (01) 37-40
- 21 Price MF, Capizzi PJ, Watterson PA, Lettieri S. Reverse sural artery flap: caveats for success. Ann Plast Surg 2002; 48 (05) 496-504
- 22 Hanasono MM, Skoracki RJ, Yu P. A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous freeflap harvest in 220 patients. Plast Reconstr Surg 2010; 125: e209-e214
- 23 Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986; 78 (03) 285-292
- 24 Karanas YL, Nigriny J, Chang J. The timing of microsurgical reconstruction in lower extremity trauma. Microsurgery 2008; 28 (08) 632-634
- 25 Coskunfirat OK, Chen HC, Spanio S, Tang YB. The safety of microvascular free tissue transfer in the elderly population. Plast Reconstr Surg 2005; 115 (03) 771-775
- 26 Griffin JR, Thornton JF. Lower extremity reconstruction. SRPS 2003; 9 (37) 1-31
- 27 Byrd HS, Cierny 3rd G, Tebbetts JB. The management of open tibial fractures with associated soft-tissue loss: external pin fixation with early flap coverage. Plast Reconstr Surg 1981; 68 (01) 73-82
- 28 Sun TB, Chien SH, Lee JT, Cheng LF, Hsu LP, Chen PR. Is dextran infusion as an antithrombotic agent necessary in microvascular reconstruction of the upper aerodigestive tract?. J Reconstr Microsurg 2003; 19 (07) 463-466
- 29 Maruccia M, Elia R, Caizzi G. et al. Free flap and kickstand external fixator in foot and ankle soft tissue reconstruction. The versatility of a microsurgical-friendly application of an orthopedic device. Injury 2018; 49 (Suppl. 03) S105-S109