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      Colgajo abdominal de patrón vertical para cobertura en miembro superior. Una opción vigente y versátil en nuestro medio Translated title: Vertical pattern abdominal flap for coverage in upper limb defects. A current and versatile option in our working environment

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          Abstract

          Resumen Introducción y objetivo. Los defectos de cobertura en la extremidad superior implican alteraciones estéticas y funcionales importantes. Como primera opción son tratados mediante microcirugía, sin embargo, en las instituciones con recursos económicos insuficientes, o en las que no está disponible este servicio, como en el Hospital San Jorge de Pereira (Colombia), los colgajos a distancia cobran gran utilidad. En la actualidad, y en nuestro medio, el colgajo abdominal de patrón vertical es nuestra primera opción para la cobertura de estos defectos. Material y método. Estudio retrospectivo de casos atendidos en el Hospital Universitario San Jorge de Pereira (Colombia) entre 2016 y 2020, en los que se realizó cobertura de áreas cruentas en miembro superior mediante colgajo abdominal de patrón vertical. Resultados. Recogimos un total de 10 colgajos, todos en varones, con una media de edad de 33.3 años. La etiología de los defectos fue quemadura eléctrica en 7 casos, accidente de tránsito en 2 y trauma cortocontundente en 1. En 9 pacientes el colgajo fue de base superior y en 1 caso de base inferior, todos bajo anestesia general con un tiempo quirúrgico de entre 90 y 120 minutos. La cobertura fue adecuada en el 100% de los casos, con una dehiscencia de sutura en zona receptora como única complicación. Conclusiones. El colgajo abdominal de patrón vertical es una opción versátil, reproducible y segura, que cobra utilidad ante la ausencia de recursos o la posibilidad de realizar microcirugía. Actualmente es nuestra primera opción en cobertura de defectos en miembro superior, permitiendo obtener resultados satisfactorios con baja tasa de complicaciones.

          Translated abstract

          Abstract Background and objective. Coverage defects in the upper limb have significant aesthetic and functional implications. Mostly this defects are treated by microsurgery, however in some institutions with limited economical resources or unavailability of this area, distant flaps become an important option for reconstruction. The vertical pattern abdominal flap is our first choice for the coverage of these defects. Methods. Retrospective study of cases with upper limb coverage defects treated with vertical pattern abdominal flap at the San Jorge de Pereira Hospital (Colombia) between 2016 and 2020. Results. Ten vertical pattern abdominal flaps were performed, all in male patients, with a mean age of 33.3 years. The etiology of the defects was electrical burn in 7 cases, traffic accident in 2 and blunt trauma in 1. In 9 patients an upper base flap was performed and in 1 a lower base flap, all of them under general anesthesia with a surgical time between 90 and 120 minutes. Adequate coverage was obtained in 100% of the cases, with suture dehiscence in flap area as the only complication. Conclusions. Vertical pattern abdominal flap is a versatile, reproducible, and safe option, useful in absence of resources or the possibility of performing microsurgery, Currently, it is our first option in upper limb covering defects, allowing to obtain satisfactory results with low complication rate.

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          The groin flap

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            Reconstruction of post-traumatic upper extremity soft tissue defects with pedicled flaps: An algorithmic approach to clinical decision making

            Purpose Pedicled flaps are still the workhorse flaps for reconstruction of upper limb soft tissue defects in many centers across the world. They are lifeboat options for coverage in vessel deplete wounds. In spite of their popularity existing algorithms are limited to a particular region of upper limb; a general algorithm involving entire upper limb which helps in clinical decision making is lacking. We attempt to propose one for the day to day clinical practice. Methods A retrospective analysis of patients who underwent pedicled flaps for coverage of post-traumatic upper extremity (arm, elbow, forearm, wrist & hand) soft tissue defects within the period of January 2016 to October 2017 was performed. Patients were divided into groups according to the anatomical location of the defects. The flaps performed for different anatomical regions were enlisted. Demographic data and complications were recorded. An algorithm was proposed based on our experience, with a particular emphasis made to approach to clinical decision making. Results Two hundred and twelve patients were included in the study. Mean age was 27.3 years (range: 1–80 years), 180 were male, and 32 were female. Overall flap success rate was 98%, the following complications were noted marginal flap necrosis requiring no additional procedure other than local wound care in 32 patients (15%), partial flap necrosis requiring flap advancement or extra flap in 15 patients (7%), surgical site infection in 11 patients (5%), flap dehiscence requiring re-suturing in 5 patients (2.4%), total flap necrosis 4 patients (2%). Conclusion The proposed algorithm allows a reliable and consistent method for addressing diverse soft tissue defects in the upper limb with high success rate.
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              Rational flap selection and timing for coverage of complex upper extremity trauma

              Reconstruction of complex extremity trauma continues to be a challenging task for plastic surgeons. Characteristics of such injuries include destruction of functional structures, often due to high energy trauma that causes significant invalidity. Before the era of free flaps, pedicled fasciocutaneous and muscle flaps were the only option for reconstruction of the severely injured upper extremity. The management of complex injuries of the upper extremity has changed with the development of reconstructive microsurgery. Nowadays, we have a great variety of different free flaps to cover defects of the upper extremity and restore function by innervated free flaps. Sensibility, skin thickness, texture, colour, durability, binding of the flap to the underlying structures, donor site morbidity, possibility of secondary reconstructive procedures, the surgeon's experience and operative facilities must all be taken into consideration for choosing the optimal reconstructive procedure. Not only the reconstructive und functional requirements but the timing of reconstruction is extremely important for final result. The purpose of this paper is to define the principles of flap selection and timing of flap reconstruction, according to the assessment of trauma in the upper limb.
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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
                March 2021
                : 47
                : 1
                : 63-72
                Affiliations
                [3] Barranquilla Atlántico orgnameUniversidad Simón Bolívar orgdiv1Hospital Universitario San Jorge de Pereira Colombia
                [2] Barranquilla Atlántico orgnameUniversidad Simón Bolívar orgdiv1Hospital Universitario San Jorge de Pereira orgdiv2Servicio de Cirugía Plástica Colombia
                [1] Barranquilla Atlántico orgnameUniversidad Simón Bolívar Colombia
                Article
                S0376-78922021000100063 S0376-7892(21)04700100063
                10.4321/s0376-78922021000100009
                a2eeab77-d093-4a9b-9d7e-121e1d604f85

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

                History
                : 29 August 2020
                : 23 November 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 10
                Product

                SciELO Spain

                Categories
                Miembro Superior

                Abdominal flap,Pedicle flap,Upper limb,Hand,Forearm,Colgajo abdominal,Colgajo pediculado,Miembro superior,Mano,Antebrazo

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