Metrika članka

  • citati u SCindeksu: 0
  • citati u CrossRef-u:0
  • citati u Google Scholaru:[=>]
  • posete u poslednjih 30 dana:8
  • preuzimanja u poslednjih 30 dana:4
članak: 2 od 5  
Back povratak na rezultate
Vojnosanitetski pregled
2019, vol. 76, br. 6, str. 620-627
jezik rada: engleski
vrsta rada: izvorni naučni članak
doi:10.2298/VSP170628139J
Creative Commons License 4.0
Neurokutani režnjevi za rekonstrukciju defekata mekih tkiva kolena, potkolenice, skočnog zgloba i stopala - kliničko iskustvo sa 32 pacijenta
aUniversity of Novi Sad, Faculty of Medicine, Novi Sad + Clinical Center of Vojvodina, Clinic for Plastic and Reconstructive Surgery, Novi Sad
bUniversity of Novi Sad, Faculty of Medicine, Novi Sad + Institute for Child and Youth Health Care of Vojvodina, Novi Sad
cUniversity of Novi Sad, Faculty of Medicine, Novi Sad + Institute of Public Health of Vojvodina, Novi Sad
dKlinički centar Novi Sad

e-adresa: mladen.jovanovic@mf.uns.ac.rs

Sažetak

Uvod/Cilj. Neurokutani ostrvasti režnjevi su vrsta fasciokutanih režnjeva čija je klinička primena u stalnom porastu poslednjih godina. Oni zauzimaju značajno mesto u rekonstruktivnoj lestvici za pokrivanje malih i srednjih defekata mekih tkiva potkolenice i stopala. Cilj ovog rada bio je da se analiziraju rezultati lečenja pacijenata sa defektima mekih tkiva donjih ekstremiteta usled traume, infekcije, uklanjanja tumora ili nestabilnog ožiljka koji su rekonstruisani različitim vrstama neurokutanih režnjeva. Metode. U ovu retrospektivnu studiju bila su uključena 32 pacijenta sa mekotkivnim defektima donjih ekstremiteta, koji su lečeni u Kliničkom Centru Vojvodine od januara 2004. do aprila 2017. Sve operacije su izvedene u regionalnoj anesteziji pod Esmarhovom poveskom. Dizajn režnjeva i dužina peteljki bili su determinisani veličinom i pozicijom recipijentne regije nakon neophodnog debridmana. Režnjevi su podizani, rotirani i pozicionirani na mesto defekta. Podaci o režnjevima i pacijentima su neposredno beleženi i sumirani. Rezultati. Pacijenti su bili pretežno muškog pola (81,2%), prosečne starosti 46,7 godina. Distalno bazirani suralni režanj je korišćen kod većine pacijenata (56,2%), zatim distalno bazirani safenski (21,9%), lateralni suralni (12,5%) i proksimalno bazirani suralni režanj (9,4%). Lokalizacija defekta je kod većine pacijenata bila na distalnoj trećini potkolenice i skočnom zglobu (53,1%). Najčešće indikacije za operaciju su bile povreda (46,9%) i hronična infekcija (31,2%). Zadovoljavajuće pokrivanje defekta postignuto je kod sva 32 pacijenta, bez ijednog izgubljenog režnja. Delimična nekroza režnja usled produžene venske kongestije je zabeležena kod 3 (9,4%) pacijenta, a zarasla odloženo ili nakon postavljanja slobodnog kožnog transplantata. Lokalna infekcija je zabeležena kod pet (15,6%) pacijenata. Znaci infekcije su se spontano povukli kod dva pacijenta, a posle hirurške revizije kod tri, kao posledica rezidualnog osteitisa tibije. Jedan od njih je nakon resekcije kosti podvrgnut ortopedskoj proceduri po Ilizarovu. Zaključak. Neurokutani režnjevi su značajna alternativa slobodnim režnjevima za rekonstrukciju defekata na donjim ekstremitetima. Učestalost kliničke primene se može objasniti činjenicom da ova hirurška procedura nije tehnički i vremenski zahtevna, te da se pri tome ne kompromituje magistralnu arterijsku cirkulaciju. Naša klinička studija potvrđuje pouzdanost i sigurnost korišćenja ovih režnjeva.

Ključne reči

Reference

Cavadas, P.C. (1997) Reversed Saphenous Neurocutaneous Island Flap: Clinical Experience. Plastic and Reconstructive Surgery, 99(7): 1940-1946
Chaput, B., Herlin, C., Espié, A., Meresse, T., Grolleau, J.L., Garrido, I. (2014) The keystone flap alternative in posttraumatic lower-extremity reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery, 67(1): 130-132
Chen, S., Chen, T., Wang, H. (2006) The distally based sural fasciomusculocutaneous flap for foot reconstruction. Journal of Plastic, Reconstructive & Aesthetic Surgery, 59(8): 846-855
Chen, X., Xu, Y., Chen, J., Ma, Z., Guan, L., Xu, J., et al. (2013) Dominant perforator neurocutaneous flaps for one-staged reconstruction of defects caused by high energy at lower legs, ankles and feet. Zhonghua Zheng Xing Wai Ke Za Zhi, 29(2): 81-7. (Chinese)
Ciofu, R.N., Zamfirescu, D.G., Popescu, S.A., Lascar, I. (2017) Reverse sural flap for ankle and heel soft tissues reconstruction. J Med Life, 10(1): 94-102
Cormack, G.C., Lamberty, B.G.H. (1984) A classification of fascio-cutaneous flaps according to their patterns of vascularisation. British Journal of Plastic Surgery, 37(1): 80-87
de Blacam, C., Colakoglu, S., Ogunleye, A.A., Nguyen, J.T., Ibrahim, A.M.S., Lin, S.J., Kim, P.S., Lee, B.T. (2014) Risk factors associated with complications in lower-extremity reconstruction with the distally based sural flap: A systematic review and pooled analysis. Journal of Plastic, Reconstructive & Aesthetic Surgery, 67(5): 607-616
Deng, C., Wei, Z.Z., Wang, B., Jin, W., Zhang, W., Tang, X., et al. (2016) The proximally based lateral superficial sural artery flap: A convenient and optimal technique for the reconstruction of soft-tissue defects around the knee. Int J Clin Exp Med, 9(8): 15167-76
Dhamangaonkar, A.C., Patankar, H.S. (2014) Reverse sural fasciocutaneous flap with a cutaneous pedicle to cover distal lower limb soft tissue defects: Experience of 109 clinical cases. Journal of Orthopaedics and Traumatology, 15(3): 225-229
Eker, G., Akan, M., Aydo, D.E., Aköz, T. (2003) Salvage of Neurocutaneous Flaps with Venous Congestion Using Intravenous Cannula. Plastic and Reconstructive Surgery, 112(4): 1191-1192
Erdmann, D., Gottlieb, N., Humphrey, S.J., Le, T.C., Bruno, W., Levin, S.L. (2005) Sural flap delay procedure: A preliminary report. Ann Plast Surg, 54(5): 562-567
Fodor, L., Horesh, Z., Lerner, A., Ramon, Y., Peled, I.J., Ullmann, Y. (2007) The Distally Based Sural Musculoneurocutaneous Flap for Treatment of Distal Tibial Osteomyelitis. Plastic and Reconstructive Surgery, 119(7): 2127-2136
Fujiwara, M., Nagata, T., Matsushita, Y., Ishikawa, K., Yusuke, O., Fukamizu, H. (2013) Delayed distally based sural flap with temporary venous supercharging. Microsurgery, 33(7): 534-538
Hasegawa, M., Torii, S., Katoh, H., Esaki, S. (1994) The Distally Based Superficial Sural Artery Flap. Plastic and Reconstructive Surgery, 93(5): 1012-1020
Herlin, C., Sinna, R., Hamoui, M., Canovas, F., Captier, G., Chaput, B. (2017) Distal lower extremity coverage by distally based sural flaps: Methods to increase their vascular reliability. Annales de Chirurgie Plastique Esthétique, 62(1): 45-54
Ilyas, T.M.U., Ellahi, I., Dar, M.F., Sharif, A. (2016) Distal Based Sural Fascio-Cutaneous Flap: A Practical Limb Saviour for Wounds of War and Peace. J Coll Physicians Surg Pak, 26(5): 399-402
Kojić, S. (2005) Significance of neurocutaneous flaps in reconstruction of foot and lower leg defects. Belgrade: University of Belgrade-Faculty of Medicine, dissertation, (Serbian)
Liu, L., Zou, L., Li, Z., Zhang, Q., Cao, X., Cai, J. (2014) The extended distally based sural neurocutaneous flap for foot and ankle reconstruction: A retrospective review of 10 years of experience. Ann Plast Surg, 72(6): 689-94
Loonen, M.P.J., Kon, M., Schuurman, A.H., Bleys, R.L.A.W. (2007) Venous Bypass Drainage of the Small Saphenous Vein in the Neurovascular Pedicle of the Sural Flap: Anatomical Study and Clinical Implications. Plastic and Reconstructive Surgery, 120(7): 1898-1905
Masquelet, A.C., Romana, M.C., Wolf, G. (1992) Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: Anatomic study and clinical experience in the leg. Plast Reconstr Surg, 89(6): 1115-1136
Nakajima, H., Imanishi, N., Fukuzumi, S., Minabe, T., Aiso, S., Fujino, T. (1998) Accompanying Arteries of the Cutaneous Veins and Cutaneous Nerves in the Extremities: Anatomical Study and a Concept of the Venoadipofascial and/or Neuroadipofascial Pedicled Fasciocutaneous Flap. Plastic and Reconstructive Surgery, 102(3): 779-791
Nuri, T., Ueda, K., Maeda, S., Otsuki, Y. (2012) Anatomical study of medial and lateral sural cutaneous nerve: Implications for innervated distally-based superficial sural artery flap. Journal of Plastic Surgery and Hand Surgery, 46(1): 8-12
Orbay, H., Ogawa, R., Ono, S., Aoki, S., Hyakusoku, H. (2011) Distally Based Superficial Sural Artery Flap Excluding the Sural Nerve. Plastic and Reconstructive Surgery, 127(4): 1749-1750
Özalp, B., Aydınol, M. (2016) Perforator-based propeller flaps for leg reconstruction in pediatric patients. Journal of Plastic, Reconstructive & Aesthetic Surgery, 69(10): e205-e211
Pan, H., Zheng, Q., Yang, S. (2014) Utility of proximally based sural fasciocutaneous flap for knee and proximal lower leg defects. Wounds, 26(5): 132-140
Parrett, B.M., Pribaz, J.J., Matros, E., Przylecki, W., Sampson, C.E., Orgill, D.P. (2009) Risk Analysis for the Reverse Sural Fasciocutaneous Flap in Distal Leg Reconstruction. Plastic and Reconstructive Surgery, 123(5): 1499-1504
Pontén, B. (1981) The fasciocutaneous flap: Its use in soft tissue defects of the lower leg. British Journal of Plastic Surgery, 34(2): 215-220
Santanelli, F., Tenna, S., Pace, A., Scuderi, N. (2002) Free Flap Reconstruction of the Sole of the Foot with or without Sensory Nerve Coaptation. Plastic and Reconstructive Surgery, 109(7): 2314-2322
Schmitt, S.K. (2017) Osteomyelitis. Infectious Disease Clinics of North America, 31(2): 325-338
Terzić, Z., Đorđević, B. (2014) Clinical aspects of reconstruction of the lower third of the leg with fasciocutaneous flap based on peroneal artery perforators. Vojnosanitetski pregled, vol. 71, br. 1, str. 39-45
Toia, F., Darpa, S., Pignatti, M., Noel, W., Cordova, A. (2017) Axial propeller flaps: A proposal for update of the 'Tokyo consensus on propeller flaps'. Journal of Plastic, Reconstructive & Aesthetic Surgery, 70(6): 857-860
Tsai, J., Liao, H.T., Wang, P.F., Chen, C.T., Lin, C.H. (2013) Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction: Patient selection and surgical refinement. Microsurgery, 33(5): 342-349
Uygur, F., Evinç, R., Noyan, N., Duman, H. (2009) Should We Hesitate to Use Subcutaneous Tunneling for Fear of Damaging the Sural Flap Pedicle?. Annals of Plastic Surgery, 63(1): 89-93
Wei, J., Dong, Z., Ni, J., Liu, L., Luo, S., Luo, Z., Zheng, L., He, A. (2012) Influence of flap factors on partial necrosis of reverse sural artery flap: A study of 179 consecutive flaps. Journal of Trauma and Acute Care Surgery, 72(3): 744-750
Wong, C., Tan, B. (2008) Maximizing the Reliability and Safety of the Distally Based Sural Artery Flap. Journal of Reconstructive Microsurgery, 24(08): 589-594
Yildirim, S., Akan, M., Aköz, T. (2002) Soft-Tissue Reconstruction of the Foot with Distally Based Neurocutaneous Flaps in Diabetic Patients. Annals of Plastic Surgery, 48(3): 258-264
Zhong, W., Lu, S., Chai, Y. (2016) Distally Based Saphenous Neurocutaneous Perforator Flap: A Versatile Donor Site for Reconstruction of Soft Tissue Defects of the Medial Malleolar Region. Journal of Foot and Ankle Surgery, 55(2): 391-396
Zhu, Y., Wang, Y., He, X., Zhu, M., Li, F., Xu, Y. (2013) Foot and ankle reconstruction: An experience on the use of 14 different flaps in 226 cases. Microsurgery, 33(8): 600-604