Lower Limb Reconstruction - Fasciocutaneous Sural Flap / Reconstrução de membro inferior- retalho fasciocutâneo sural

Abstract Objective The present study aims to evaluate the use of the reverse-flow sural fasciocutaneous flap to cover lesions in the distal third of the lower limb. Methods A total of 24 cases were analyzed, including 20 traumatic injuries, 3 sports injuries, and 1 case of tumor resection. Results Among the 24 evaluated medical records, 16 patients were male, and 8 were female. Their age ranged from6 to 75 years old. Most of the patients evolved with total healing of the flap (n= 21). There was only one case of total necrosis of the flap in an insulin-dependent diabetic, high blood pressure patient, evolving to subsequent limb amputation. In two cases, there was partial necrosis and subsequent healing by secondary intention; one of these patients was a heavy smoker. Complications were associated with comorbidities and, unlike other studies, no correlation was observed with the learning curve. There was also no correlation with the site or size of the lesion to be covered. Conclusion It is clinically relevant that the success rate of the reverse-flow sural fasciocutaneous flap technique was of 87.5%. This is a viable and effective alternative in the therapeutic arsenal for complex lower limb lesions.

Resumo Objetivo Avaliar o uso do retalho fasciocutâneo sural de fluxo reverso na cobertura de lesões no terço distal dos membros inferiores. Métodos Foram analisados 24 casos, 20 de origem traumática, três por lesões esportivas e um por ressecção de lesão tumoral. Resultados Dos 24 prontuários avaliados, 16 eram homens e oito mulheres. A idade variou de seis a 75 anos. A maioria dos pacientes evoluiu com cicatrização total do retalho (21). Houve apenas um caso de necrose total do retalho em paciente diabético insulinodependente e hipertenso, evoluiu para posterior amputação do membro. Em dois casos, houve necrose parcial composterior cicatrização por segunda intenção, um desses pacientes era tabagista pesado. As complicações foram associadas às comorbidades e, ao contrário do evidenciado por outros estudos, não houve correlação com a curva de aprendizado. Também não houve correlação com o local ou o tamanho da lesão a ser coberta. Conclusão Tem-se como relevância clinica que a técnica de retalho fasciocutâneo sural de fluxo reverso usada obteve 87,5% de sucesso, é uma opção viável e eficaz no arsenal terapêutico das lesões complexas dos membros inferiores.

Vocal Fold Augmentation by Transplantation of Autologous Fat and Fascia: An Experimental Study / 听力学及言语疾病杂志

Objective To compare the histological fates and the effects of autologous fat and fascia used as augmentative materials to treat unilateral vocal fold paralysis (UVFP). Methods Vocal fold augmentation with autologous fat and fascia was performed on 2 dogs (group A) to cure glottic insufficiency caused by left vocal fold paralysis. Autologous fat and fascia 0.4 ml were injected respectively into left and right vocal folds of 9 dogs (group B). The dogs of group B were killed after 1,3 and 5 months and the dogs of group A were killed after 8 months. The histology of both substances and the effect of treatment were evaluated. Results Surviving autologous fat grafts was found in the canine vocal fold after 8 months, but the absorption was too rapid to maintain the bulk of grafts, the effect could last no more than 5 months. Autologous fascia also survived after 8 months, Conclusion The results showed that these two augmentative materials were both effective in the treatment of IJVFP. Autologous fat can only be used as short - term augmentative material. However, autologous fascia has a potential use for long - term application to correct glottic insufficiency caused by UVFP and other diseases.