Análise dos resultados do tratamento cirúrgico utilizando o retalho sural / Analysis of the results of surgical treatment using the sural flap

RESUMO Introdução: Fraturas complexas e extensas lesões de pele estão cada vez mais comuns devido aos traumas de alta energia. Uma alternativa para o tratamento dessas lesões nos membros inferiores é a utilização do retalho sural. Métodos: Esse foi um estudo retrospectivo, analítico-descritivo de análise exploratória documental de pacientes submetidos ao retalho sural em um hospital de referência em trauma do norte de Santa Catarina, Brasil. Foram analisados a idade, sexo, lateralidade, causa, local e tamanho da lesão, uso de tunelização e enxerto de pele, complicações e seus fatores de risco, além do manejo de tais complicações. Resultados: A amostra do estudo foi composta por 16 pacientes, com média de idade de 44,4 anos, 87,5% eram do sexo masculino. A causa da lesão mais prevalente foi trauma (75,0%) e o local da lesão foi mais prevalente na tíbia distal (43,8%). Em 50,0% dos casos os fatores de risco para as complicações estavam presentes, sendo que pacientes com diabetes mellitus e tabagistas exibiram 5 vezes mais chances de apresentar tais complicações. Necrose parcial teve uma prevalência de 25,0%, sendo que em 18,8% foi realizado apenas debridamento e em 6,3% enxertia. Conclusão: O retalho sural é uma boa alternativa para a cobertura de lesões dos membros inferiores devido ao bom índice de sucesso, mas não está livre de complicações. Tais complicações são mais prevalentes em pacientes que possuem fatores de risco como o tabagismo e diabetes mellitus.

ABSTRACT Introduction: Complex fractures and extensive skin lesions are increasingly common due to high-energy traumas. An alternative for treating these lesions in the lower limbs is the use of the sural flap. Methods: This was a retrospective, analytical-descriptive study of exploratory documental analysis of patients submitted to the sural flap in a trauma reference hospital in northern Santa Catarina, Brazil. Age, sex, laterality, cause, place, and size of the lesion, use of tunneling and skin grafting, complications and their risk factors, and the management of such complications were analyzed. Results: The study sample consisted of 16 patients with a mean age of 44.4 years; 87.5% were male. The cause of the most prevalent lesion was trauma (75.0%), and the site of the lesion was more prevalent in the distal tibia (43.8%). In 50.0% of the cases, risk factors for complications were present, and patients with diabetes mellitus and smokers were five times more likely to present such complications. Partial necrosis had a prevalence of 25.0%, and in 18.8%, only debridement was performed, and 6.3% grafting was performed. Conclusion: The sural flap is a good alternative for covering lower limbs lesions due to its good success rate, but it is not free of complications. Such complications are more prevalent in patients who have risk factors such as smoking and diabetes mellitus.

Analysis of the Clinical and Radiological Results of Bridge Plate Versus External Fixation in Comminuted Distal Radius Fractures.

Objective To evaluate and compare the clinical and radiological outcomes of patients with comminuted distal radius fractures treated with an external fixator or a dorsal bridge plate. Methods In total, 45 patients were analyzed 1 year after surgery; 18 were treated with an external fixator, and 25 received a dorsal bridge plate. An analog pain scale and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were applied, in addition to radiographic, strength and range of motion assessments. Statistical analyzes were performed using the chi-squared test and the Mann-Whitney non-parametric test. Results Fractures were more common in women over 60 years old who suffered falls from their own height. Both methods demonstrated similar functional and radiological results. Infections were more prevalent in patients receiving external fixators, but their residual grip strength was better. Reflex sympathetic neuropathy was more common in subjects treated with a dorsal bridge plate. Conclusion Our analysis showed no consensus on the superiority of one method over the other. Each method had advantages and disadvantages, but both led to good, similar outcomes. The treatment must be chosen according to the profile of the trauma, the patient's clinical conditions, the surgeon's experience, and the availability of materials.