Retalho plantar medial para reconstrução de defeitos em calcanhar após ressecção de melanoma lentiginoso acral: Uma série de 7 casos / Medial plantar flap for reconstruction of heel defects after resection of acral lentiginous melanoma: A series of seven cases

Introdução: A reconstrução da região plantar ainda é um dos grandes desafios da cirurgia plástica reconstrutiva. Os tecidos dessa região apresentam características únicas e que são essenciais para a manutenção da funcionalidade do membro. De toda a região plantar, a região do calcanhar é a área de maior sustentação do peso e submetida ao maior impacto. O retalho fasciocutâneo plantar medial é uma das opções reconstrutivas, pois representa tecido semelhante e mantém a sensibilidade para a área receptora. Método: Foi realizado um estudo retrospectivo através da coleta de dados de prontuário de pacientes que realizaram reconstruções da região do calcanhar com retalho plantar medial, no período de julho de 2013 a setembro de 2019. O estudo foi aprovado pelo Comitê de Ética para Análise de Projetos de Pesquisa do HCFMUSP (Número CAAE: 56849422.0.0000.0068). Resultados: A reconstrução de calcanhar após ressecção de melanoma lentiginoso acral foi realizada em 7 pacientes. Complicações cirúrgicas foram observadas em 3 pacientes, sendo que todos eles tinham idade acima de 50 anos e/ou alguma comorbidade associada. Houve 57,1% de complicações, sendo 37,5% relacionadas ao retalho e 12,5% relacionadas à área doadora. Ocorreram 3 necroses totais de retalho (42,9%) e 1 perda total de enxerto na área doadora (14,3%). Conclusão: O retalho plantar medial se apresenta como uma boa alternativa para a realização de reconstruções oncológicas de defeitos na região plantar do pé. Contudo, deve-se ponderar a escolha do paciente ideal e lembrar que a dissecção do seu pedículo vascular não é de fácil execução.

Introduction: Resurfacing the sole is still one of the great challenges of reconstructive plastic surgery. The tissues on the sole of the foot have unique characteristics essential for maintaining the limbs functionality. The heel has the most significant weight support and is subjected to the entire soles greatest impact. The medial plantar artery flap is one of the reconstructive options, as it represents similar tissue and maintains sensitivity to the recipient area. Methods: A retrospective study was performed by collecting data from medical records of patients who underwent reconstructions of the heel with a medial plantar artery flap from July 2013 to September 2019. The study was approved by the Ethics Committee for Analysis of Research Projects of HCFMUSP (CAAE number: 56849422.0.0000.0068). Results: Heel reconstruction was performed in 7 patients after acral lentiginous melanoma excision. Surgical complications were observed in 3 patients, all of whom were aged over 50 years or have associated comorbidity. There were 57.1% of complications, 37.5% related to the flap, and 12.5% related to the donor area. There were three total flap necroses (42.9%) and one total graft loss in the donor area (14.3%). Conclusion: The medial plantar flap presents itself as a good alternative for performing oncological reconstructions of defects in the plantar region of the foot. However, the choice of the ideal patient should be considered and we must remember that the dissection of its vascular pedicle is not easily executed.

Retalho supraclavicular para reconstrução oncológica em cabeça e pescoço: Uma série de 62 casos / Supraclavicular flap for head and neck oncological reconstruction: A series of 62 cases

Introdução: A reconstrução oncológica de defeitos extensos em cabeça e pescoço impõe ao cirurgião plástico a difícil decisão entre o uso de retalhos livres e retalhos pediculados. O retalho supraclavicular é um dos principais exemplos de retalho pediculado, sendo versátil, com espessura delgada e cor semelhante à região a ser reconstruída. Método: Um estudo retrospectivo foi realizado através da coleta de dados de prontuário de pacientes internados no Instituto do Câncer do Estado de São Paulo, entre dezembro de 2010 e março de 2020. Resultados: Dentre os 62 pacientes reconstruídos com retalho supraclavicular, 37 eram do sexo masculino e 25 do sexo feminino. Cinquenta e oito pacientes (93,5%) possuíam alguma comorbidade associada. Ao todo, 27 complicações relacionadas ao retalho (43,5%) foram registradas, sendo 5 necroses totais (8%). Conclusão: O retalho supraclavicular possui importante papel nas reconstruções oncológicas de cabeça e pescoço e deve ser considerado como opção em pacientes maus candidatos a retalhos microcirúrgicos.

Introduction: The oncological reconstruction of extensive defects in the head and neck requires the plastic surgeon to make a difficult decision between the use of free flaps and pedicled flaps. The supraclavicular flap is one of the main examples of a pedicled flap, being versatile, with a thin thickness and similar color to the region to be reconstructed. Method: A retrospective study was carried out by collecting data from medical records of patients admitted to the Cancer Institute of the State of São Paulo between December 2010 and March 2020. Results: Among the 62 patients reconstructed with a supraclavicular flap, 37 were male and 25 female. Fifty-eight patients (93.5%) had some associated comorbidity. In total, 27 complications related to the flap (43.5%) were recorded, 5 of which were total necrosis (8%). Conclusion: The supraclavicular flap plays an important role in head and neck oncological reconstructions and should be considered as an option in patients who are poor candidates for microsurgical flaps.

Paramedian forehead flap in the treatment of nasal, non-melanoma skin cancer: a cross-sectional study.

INTRODUCTION: nose is the central point of the face and vulnerable to the occurence of non-melanoma skin cancer (NMSC), impacting on appearance. The paramedian forehead flap (PMFF) is considered the best option to treat extensive nasal defects. The objective of this study is to present the experience on PMFF for nasal reconstruction in the treatment of NMSC of a cancer referral center. METHODS: retrospective study was carried out through data from medical records of patients who underwent nasal reconstruction with PMFF due to NMSC at the Cancer Institute of the State of São Paulo (ICESP). RESULTS: 111 patients were identified, mostly ederly, with comorbidities and on initial tumors (T1 and T2). Basal cell carcinoma (BCC) was the predominant histological type. Dorsum and tip were the most affected subunitis. In addition to skin coverage, reconstruction of the lining and structural framework was also performed in half of the cases. Second intention healing was the technique of choice in closing the donor area. Pedicle division ocurred predominantly in the second operation and the median time to complete reconstruction was 6 months. There were low complication rates. CONCLUSIONS: the PMFF is safe and effective to treat nose NMSC, even in cases of high complexity. Since the treatment time can be prolonged and impact on quality of life, it is essential to emphasize and discuss this aspect with the patients before surgery.

A versatilidade e confiabilidade do retalho Keystone em reconstruções oncológicas / Versatility and reliability of the Keystone flap in oncological reconstructions

Introdução: O retalho Keystone é um retalho em ilha, de vascularização confiável e dissecção simples, descrito pela primeira vez em 2003. Apesar de suas vantagens, é ainda pouco citado na literatura especializada e longe de se tornar opção de escolha na prática clínica da cirurgia reconstrutiva. O objetivo deste artigo é apresentar a experiência de um serviço oncológico de alta complexidade no uso de retalhos Keystone em reconstruções. Métodos: Um estudo retrospectivo foi desenvolvido por meio do levantamento de dados de prontuário de pacientes operados pela equipe de Cirurgia Plástica do Instituto do Câncer do Estado de São Paulo, além de análise de registros fotográficos pré, intra e pós-operatórios. Resultados: Nove pacientes foram identificados, todos portadores de comorbidades e média de idade de 52,7 anos. Os defeitos cutâneos se seguiram após ressecções oncológicas, sendo cinco em extremidades inferiores, três em tronco e um em face. A média da área ressecada foi de 52,6cm2. As reconstruções foram realizadas sob abreviado tempo cirúrgico. Não houve complicações pós- operatórias ou perdas do retalho e o tempo de hospitalização médio foi de 2,2 dias. Conclusão: O retalho Keystone é uma opção tecnicamente simples e reprodutível para a cobertura de ferimentos de tamanhos diversos e em localizações variadas. Devido à sua confiabilidade, dissecção simples e rápida, abreviado tempo de internação e baixa morbidade à área doadora, deve ser considerado na reconstrução de feridas oncológicas de diversas localizações, em pacientes de todas as idades.

Introduction: The Keystone flap is an island flap with reliable vascularization and simple dissection, first described in 2003. Despite its distinct advantages, there are few scientific publications on this matter, and it is not a common option in the clinical practice of reconstructive surgery. This article aims to report the experience of a cancer referral center with Keystone flaps in oncological reconstructions. Methods: A retrospective study was carried out data from medical records of patients who performed oncological plastic reconstruction with keystone flaps, operated by the Surgery team of the Cancer Institute of the State of São Paulo, in addition to the analysis of pre, intra and postoperative photographic records. Results: Nine patients were identified, all with comorbidities and a mean age of 52.7. Skin defects followed after oncological resections: five in the lower extremities, three in the trunk and one in the face. The mean of the skin resected area was 52.6cm2. The reconstructions were performed under shortened surgical time. There were no postoperative complications or flap losses. The average hospital stay was 2.2 days. Conclusion: The Keystone flap is technically simple and a reproducible option for covering wounds of different sizes and locations. Due to its reliability, simple and quick dissection, shortened hospital stay and low morbidity in the donor area, it should be considered for reconstructing cancer wounds from different locations in patients of all ages.

Paramedian forehead flap in the treatment of nasal, non-melanoma skin cancer: a cross-sectional study / Retalho frontal paramediano no tratamento do câncer de pele não-melanoma de nariz: um estudo transversal

ABSTRACT Introduction: nose is the central point of the face and vulnerable to the occurence of non-melanoma skin cancer (NMSC), impacting on appearance. The paramedian forehead flap (PMFF) is considered the best option to treat extensive nasal defects. The objective of this study is to present the experience on PMFF for nasal reconstruction in the treatment of NMSC of a cancer referral center. Methods: retrospective study was carried out through data from medical records of patients who underwent nasal reconstruction with PMFF due to NMSC at the Cancer Institute of the State of São Paulo (ICESP). Results: 111 patients were identified, mostly ederly, with comorbidities and on initial tumors (T1 and T2). Basal cell carcinoma (BCC) was the predominant histological type. Dorsum and tip were the most affected subunitis. In addition to skin coverage, reconstruction of the lining and structural framework was also performed in half of the cases. Second intention healing was the technique of choice in closing the donor area. Pedicle division ocurred predominantly in the second operation and the median time to complete reconstruction was 6 months. There were low complication rates. Conclusions: the PMFF is safe and effective to treat nose NMSC, even in cases of high complexity. Since the treatment time can be prolonged and impact on quality of life, it is essential to emphasize and discuss this aspect with the patients before surgery.

RESUMO Introdução: o nariz é o ponto central da face e vulnerável à ocorrência de câncer de pele não-melanoma (CPNM), com impacto potencial na aparência. O retalho frontal paramediano (RFPM) é considerado a melhor opção para o tratamento de defeitos extensos no nariz. O objetivo deste estudo é apresentar a experiência de um centro oncológico de referência no uso de RFPM para reconstrução nasal no tratamento do CPNM. Métodos: estudo retrospectivo foi desenvolvido através do levantamento de dados de prontuário de pacientes submetidos à reconstrução nasal com RFPM devido à CPNM no Instituto do Câncer do Estado de São Paulo (ICESP). Resultados: 111 pacientes foram identificados, a maioria idosos, com comorbidades e portadores de tumores iniciais (T1 e T2). O carcinoma basocelular (CBC) foi o tipo histológico predominante. Dorso e ponta foram as subunidades mais acometidas. Além da cobertura cutânea, em metade dos casos foi realizada também a reconstrução do forro ou arcabouço do nariz. Cicatrização por segunda intenção foi a técnica de escolha no fechamento da área doadora. A liberação do pedículo foi realizada predominantemente no segundo tempo cirúrgico e o tempo para finalização do tratamento teve mediana de 6 meses. Houve baixa taxa de complicações. Conclusões: o RFPM é seguro e eficaz no tratamento do CPNM nasal, mesmo em casos de elevada complexidade. O tempo total de tratamento pode ser prolongado e impactar na qualidade de vida, sendo fundamental enfatizar e discutir este aspecto com o paciente antes da cirurgia.

Application of FACE-Q and NOSE in Nasal Reconstruction with Paramedian Frontal Flap after Skin Cancer Resection.

INTRODUCTION: Nonmelanoma skin cancer (NMSC) is responsible for high morbidity and mortality, resulting in a high cost to the health system. The nose is the leading region affected by this type of tumor and may need reconstruction by tissue transfer. The paramedian forehead flap (PFF) is one of the main options used, and the factors that influence the result should be studied. The FACE-Q questionnaire allows the assessment of appearance, quality of life, and side effects related to the procedure, whereas the Nasal Obstruction Symptom Evaluation questionnaire enables the nose function evaluation. METHODS: This study evaluates nasal reconstruction with a PFF after resection of NMSC with the FACE-Q questionnaire and Nasal Obstruction Symptom Evaluation. Spearman Rank correlation coefficient tests between the questionnaire results and patients' characteristics were performed. RESULTS: The questionnaires were completely answered by 49 patients who underwent this reconstruction between 2011 and 2019 in a cancer center. The patients' evaluations demonstrate high satisfaction with appearance, quality of life, side effects, and function. Completing reconstruction under 6 months was associated with a higher quality of life among patients (P = 0.002). Reconstruction of lining or scaffold, moment of flap division, complications, and number of operations did not show an association. CONCLUSION: This study suggests that the PFF is a reliable option for nasal reconstruction. Identifying the total reconstruction time as an impact factor on patients' quality of life should be considered when planning treatment.