Subscribe to RSS
DOI: 10.1055/s-0041-1740199
Análise comparativa do tratamento de lesões cutâneas dos membros inferiores com retalho sural versus retalho propeller[*]
Article in several languages: português | English Fontes de Financiamento A presente pesquisa não recebeu nenhuma bolsa específica de agências de fomento nos setores público, comercial ou sem fins lucrativos.
Resumo
Objetivo O objetivo do presente estudo foi comparar prospectivamente os retalhos sural e propeller para cobertura de partes moles da extremidade inferior. Foram avaliadas as seguintes variáveis: incidência de perda total ou parcial do retalho e morbidade da área doadora (fechamento primário versus enxerto de pele).
Métodos Análise prospectiva e randomizada de dados coletados de todos os pacientes apresentando defeitos em tecidos moles da extremidade distal da perna e do retropé submetidos aos retalhos em questão.
Resultados Foram avaliados 24 pacientes com idades entre 4 e 60 anos, entre 2011 e 2017. Cobertura completa foi obtida em 22 dos 24 pacientes (91,6%) e observamos falha em 2 retalhos (8,4%). O retalho sural, sendo a opção mais popular, continua a representar uma alternativa segura e versátil para defeitos cutâneos do terço distal da perna e da região do calcanhar. O retalho propeller, da mesma maneira, mostrou-se uma opção comparável para o tratamento destas lesões desafiadoras.
Conclusão Os retalhos sural e propeller são boas opções para a cobertura de partes moles da extremidade inferior, demostrando baixas taxas de complicações como perda parcial ou total do retalho.
* Trabalho desenvolvido no Grupo de Mão e Microcirurgia do Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil.
Publication History
Received: 18 March 2021
Accepted: 13 August 2021
Article published online:
09 February 2022
© 2022. 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/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
Referências
- 1 Zhang F, Lin S, Song Y, Zhang G, Zheng H. Distally based sural neuro-lesser saphenous veno-fasciocutaneous compound flap with a low rotation point: microdissection and clinical application. Ann Plast Surg 2009; 62 (04) 395-404
- 2 Aoki S, Tanuma K, Iwakiri I. et al. Clinical and vascular anatomical study of distally based sural flap. Ann Plast Surg 2008; 61 (01) 73-78
- 3 Jakubietz RG, Jakubietz MG, Gruenert JG, Kloss DF. The 180-degree perforator-based propeller flap for soft tissue coverage of the distal, lower extremity: a new method to achieve reliable coverage of the distal lower extremity with a local, fasciocutaneous perforator flap. Ann Plast Surg 2007; 59 (06) 667-671
- 4 Tos P, Innocenti M, Artiaco S. et al. Perforator-based propeller flaps treating loss of substance in the lower limb. J Orthop Traumatol 2011; 12 (02) 93-99
- 5 Noack N, Hartmann B, Küntscher MV, Ku MV. Measures to prevent complications of distally based neurovascular sural flaps. Ann Plast Surg 2006; 57 (01) 37-40
- 6 Moscatiello F, Masià J, Carrera A, Clavero JA, Larrañaga JR, Pons G. The ‘propeller’ distal anteromedial thigh perforator flap. Anatomic study and clinical applications. J Plast Reconstr Aesthet Surg 2007; 60 (12) 1323-1330
- 7 Costa-Ferreira A, Reis J, Pinho C, Martins A, Amarante J. The distally based island superficial sural artery flap: clinical experience with 36 flaps. Ann Plast Surg 2001; 46 (03) 308-313
- 8 Rajendra Prasad JS, Cunha-Gomes D, Chaudhari C, Bhathena HM, Desai S, Kavarana NM. The venoneuroadipofascial pedicled distally based sural island myofasciocutaneous and muscle flaps: anatomical basis of a new concept. Br J Plast Surg 2002; 55 (03) 203-209
- 9 Murakami M, Hyakusoku H, Ogawa R. The multilobed propeller flap method. Plast Reconstr Surg 2005; 116 (02) 599-604
- 10 Lu TC, Lin CH, Lin CH, Lin YT, Chen RF, Wei FC. Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg 2011; 64 (03) 386-393
- 11 Pignatti M, Ogawa R, Hallock GG. et al. The “Tokyo” consensus on propeller flaps. Plast Reconstr Surg 2011; 127 (02) 716-722
- 12 Panse NS, Bhatt YC, Tandale MS. What is safe limit of the perforator flap in lower extremity reconstruction? Do we have answers yet?. Plast Surg Int 2011; 2011: 349357
- 13 Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 1992; 89 (06) 1115-1121
- 14 Akhtar S, Ahmad I, Khan AH, Khurram MF. Modalities of soft-tissue coverage in diabetic foot ulcers. Adv Skin Wound Care 2015; 28 (04) 157-162
- 15 Demiri E, Tsimponis A, Pavlidis L, Spyropoulou GA, Foroglou P, Dionyssiou D. Reverse neurocutaneous vs propeller perforator flaps in diabetic foot reconstruction. Injury 2020; 51 (Suppl. 04) S16-S21
- 16 Ibrahim A, Oneisi A. Lower Extremity Reconstruction. In: Abu-Sittah G, Hoballah J, Bakhach J. editors. Reconstructing the War Injured Patient. Cham, Switzerland: Springer Internacional Publishing; 2017: 79-88
- 17 Taylor GI, Daniel RK. The anatomy of several free flap donor sites. Plast Reconstr Surg 1975; 56 (03) 243-253
- 18 Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region. A preliminary report. Scand J Plast Reconstr Surg 1983; 17 (03) 191-196
- 19 Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg 1991; 44 (01) 53-54
- 20 Cho AB, Pohl PH, Ruggiero GM, Aita MA, Mattar TG, Fukushima WY. The proximally designed sural flap based on the accompanying artery of the lesser saphenous vein. J Reconstr Microsurg 2010; 26 (08) 501-508