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      Colgajos locorregionales para defectos complejos de pierna y pie: uso actual en hospitales públicos de Montevideo, Uruguay Translated title: Locoregional flaps for complex leg and foot defects: valid options in public hospitals of Montevideo, Uruguay

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          Abstract

          Resumen Introducción y objetivo. Las heridas complejas de pierna y pie representan un desafío para la Cirugía Plástica, más aún cuando se asocian a fracturas expuestas dada la escasa disponibilidad de tejido local y regional. En estos casos suele plantearse la indicación de colgajos microquirúrgicos. En nuestro medio, donde la infraestructura aún está en desarrollo y no siempre se cuenta con equipamiento, horas de bloque quirúrgico para cirugías prolongadas, personal de enfermería capacitado, y hay poca colaboración de los pacientes para la recuperación, es frecuente optar por colgajos fasciocutaneos y musculares pediculados para la reconstrucción de estos defectos a pesar de que también esté indicado un colgajo libre. El objetivo de este trabajo es mostrar nuestra experiencia en hospitales públicos de Montevideo, Uruguay, en reconstrucción de pierna y pie utilizando colgajos locorregionales con buenos resultados y tiempo de recuperación aceptable. Material y método. Realizamos un estudio descriptivo retrospectivo de 7 casos de diferentes opciones terapéuticas de colgajos locorregionales fasciocutáneos y musculares para cobertura de diferentes defectos complejos de pierna y pie, en el Hospital de Clínicas y en el Instituto Nacional de Ortopedia y Traumatología de Montevideo. Seleccionamos los casos dentro de las etiologías más frecuentes de heridas en esta topografía que requieren reconstrucción por Cirugía Plástica y representan el modelo de colgajo realizado en cada tipo de herida descrito (topografía, tamaño y tejidos expuestos). Resultados. Presentamos 7 pacientes de entre 21 y 80 años de edad, en los que se realizaron colgajos musculares de gemelo interno, externo, hemitríceps, hemitríceps con tibial anterior, hemisoleo, fasciocutáneo de transposición y fasciocutáneo en isla sural. Los resultados fueron aceptables en cuanto a ausencia de complicaciones de los colgajos, no necesidad de revisiones y tiempo de recuperación de 2 a 6 meses. Conclusiones. Los colgajos locorregionales descritos proporcionan cobertura satisfactoria en defectos complejos de pierna y pie cuando los colgajos microquirúrgicos, aún estando indicados, no pueden realizarse por déficit de material, infraestructura o personal de la salud, así como por falta de colaboración del paciente para la recuperación. Las opciones planteadas pueden formar parte del algoritmo terapéutico en centros que comparten la misma epidemiología y recursos que los nuestros.

          Translated abstract

          Abstract Background and objective. Complex leg and foot wounds represent a challenge for Plastic Surgery, and even more so when they are associated with exposed fractures, given the limited availability of local and regional tissue. In these cases, the indication of microsurgical flaps is usually considered. In our environment, where the infrastructure is still under development and equipment is not always available, neither hours of surgical block for prolonged surgeries, trained nursing personnel, added to the little collaboration of patients for recovery, it is frequent to opt for fasciocutaneous flaps and pedicled muscle flaps for reconstruction, even though a free flap is also indicated. The objective of this paper is to show our experience in public hospitals in Montevideo, Uruguay, in leg and foot reconstruction using locoregional flaps, with good results and acceptable recovery time. Methods. We performed a retrospective descriptive study, in which 7 cases of different therapeutic options were described within the fasciocutaneous and muscular locoregional flaps to cover different complex leg and foot defects, from the Hospital de Clínicas and Instituto Nacional de Ortopedia y Traumatología in Montevideo, Uruguay. The cases were selected within the most frequent etiologies of wounds in this topography that require reconstruction by Plastic Surgery, and represents the flap model performed in each type of wound described (topography, size, exposed tissues). Results. We present 7 patients between 21 and 80 years of age, in whom internal, external twin muscle flaps, hemitriceps, hemitriceps with anterior tibial, hemisoleous, transpositional fasciocutaneous, fasciocutaneous in sural island flaps were performed. The results were acceptable in terms of the absence of flap complications, the lack of flap reviews and based on the recovery time from 2 to 6 months. Conclusions. The locoregional flaps described provide satisfactory coverage in complex leg and foot defects when the microsurgical flaps, even when indicated, cannot be performed due to deficits in material, infrastructure or health personnel, as well as due to patient's lack of collaboration in recovery. The options proposed may be part of the therapeutic algorithm in centers that share the same epidemiology and resources as ours.

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          Classification of the vascular anatomy of muscles: experimental and clinical correlation.

          Five patterns of muscle circulation, based on studies of the vascular anatomy of muscle, are described. Clinical and experimental correlation of this classification is determined by the predictive value of the vascular pattern of each muscle currently useful in reconstructive surgery in regard to the following parameters: arc of rotation, skin territory, distally based flaps, microvascular composite tissue transplantation, and design of muscle-delay experimental models. This classification is designed to assist the surgeon both in choice and design of the muscle and musculocutaneous flap for its use in reconstructive surgery.
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            Muscle flaps and their role in limb salvage.

            Muscle flaps have proved to be a valuable and versatile tool in the surgical treatment of the severely compromised lower extremity. Utilized as both local pedicle flaps and free tissue transfers, muscles have been successfully employed to cover complex wounds, manage osteomyelitis, salvage infected vascular grafts, treat recalcitrant venous stasis ulcers, preserve amputation levels, and restore motion following compartment syndrome. Free flap pedicles have also been used in a flow-through fashion to create a distal arterial bypass. This article explores the multipurpose role of muscle flaps in limb salvage surgery and their beneficial physiologic characteristics in hostile wound environments.
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              Reconstruction of Ankle and Heel Defects with Peroneal Artery Perforator-Based Pedicled Flaps

              Background The reconstruction of ankle and heel defects remains a significant problem for plastic surgeons. The following options exist for reconstructing such defects: local random flaps, reverse flow island flaps, and free flaps. However, each of these methods has certain drawbacks. Peroneal artery perforators have many advantages; in particular, they are predictable and reliable for ankle and heel reconstructions. In this study, we report our clinical experience with peroneal artery perforator-based pedicled flaps in ankle and heel reconstructions. Methods From July 2005 to October 2012, 12 patients underwent the reconstruction of soft tissue defects in the ankle and heel using a peroneal artery perforator-based pedicled flap. These 12 cases were classified according to the anatomical area involved. The cause of the wound, comorbidities, flap size, operative results, and complications were analyzed through retrospective chart review. Results The mean age of the patients was 52.4 years. The size of the flaps ranged from 5×4 to 20×8 cm2. The defects were classified into two groups based on whether they occurred in the Achilles tendon (n=9) or heel pad (n=3). In all 12 patients, complete flap survival was achieved without significant complications; however, two patients experienced minor wound dehiscence. Nevertheless, these wounds healed in response to subsequent debridement and conservative management. No patient had any functional deficits of the lower extremities. Conclusions Peroneal artery perforator-based pedicled flaps were found to be a useful option for the reconstruction of soft tissue defects of the ankle and heel.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                June 2020
                : 46
                : 2
                : 197-206
                Affiliations
                [2] Montevideo orgnameHospital de Clínicas Dr. Manuel Quintela Uruguay
                [3] Montevideo orgnameHospital de Clínicas Dr. Manuel Quintela Uruguay
                [1] Montevideo orgnameHospital de Clínicas Dr. Manuel Quintela Uruguay
                Article
                S0376-78922020000300013 S0376-7892(20)04600200013
                10.4321/s0376-78922020000300009
                9dfacfd8-9df3-413c-a703-147423dc1c22

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 12 April 2020
                : 21 January 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 10
                Product

                SciELO Spain

                Categories
                Reconstructiva

                Extremidad inferior,Cirugía reconstructiva,Traumatismos pierna,Colgajos quirúrgicos,Reconstructive surgery,Leg injuries,Lower extremity,Surgical flaps

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