Experiencia con colgajos libres en un centro médico colombiano de alta complejidad / Experience with free flaps in a highly complex Colombian medical center

Introducción y objetivo: La transferencia de tejido libre se ha convertido en una herramienta cada vez más importante en la Cirugía Plástica Re-constructiva. A pesar de las altas tasas de éxito reportadas en la literatura, el procedimiento puede fallar por variables ajenas a la técnica quirúrgica. Realizamos este estudio con el objetivo de conocer la frecuencia de complicaciones en un grupo de pacientes sometidos a transferencia de tejido libre en la Clínica Los Nogales en Bogotá, Colombia, así como determinar los factores ajenos a la técnica quirúrgica con el fin de proponer medidas que optimicen la probabilidad de éxito del procedimiento. Material y métodos: Estudio descriptivo, serie de casos, en el que analizamos retrospectivamente las historias clínicas de 40 pacientes sometidos a reconstrucción con colgajo libre durante los años 2017 a 2021. Evaluamos las variables preoperatorias, intraoperatorias y postoperatorias de cada uno de estos pacientes. Resultados: Los 40 casos de transferencia de tejido libre incluyeron 37 reconstrucciones (92.5%) secundarias a resección oncológica y 3 a trauma agudo (7.5%). El colgajo anterolateral de muslo (ALT) fue el colgajo libre realizado con mayor frecuencia (50%), seguido del colgajo de perforantes de la arteria epigástrica inferior profunda (DIEP) (22.5%), el colgajo libre de peroné (17.5%) y el colgajo radial (10%). El 15% de las reconstrucciones fueron fallidas: en el 10% de los casos por trombosis venosa y en el 5% de los casos por trombosis arterial de la anastomosis. La edad, la radioterapia y el nivel de hemoglobina preoperatoria parecen no afectar la supervivencia del colgajo. El tabaquismo fue determinante en la ocurrencia de complicaciones importantes del colgajo. Las complicaciones médicas postoperatorias ocurrieron en el 20% de los casos, predominando las cardíacas. (AU)

Background and objective: Free tissue transfer has become an increasingly important tool in Plastic Reconstructive Surgery. Despite the high success rates reported in the literature, the procedure can fail due to variables unrelated to the surgical technique. We carried out this study to know the frequency of complications in a group of patients undergoing free tissue transfer at the Clínica Los Nogales in Bogotá, Colombia, as well as determining factors unrelated to the surgical technique to propose measures that optimize the probability of success of the procedure. Methods: Descriptive case series study, in which we retrospectively analyzed the medical records of 40 patients undergoing free flap reconstruction between 2017 and 2021. We evaluated the preoperative, intraoperative, and postoperative variables of each of these patients. Results: The 40 cases of free tissue transfer included 37 reconstructions (92.5%) secondary to oncological resection and 3 to acute trauma (7.5%). The anterolateral thigh (ALT) flap was the most frequently performed free flap (50%), followed by the deep inferior epigastric artery perforator (DIEP) flap (22.5%), the fibular free flap (17.5%) and the radial flap (10%). Fifteen per cent of the reconstructions were unsuccessful: in 10% of cases due to venous thrombosis, and in 5% of cases due to arterial thrombosis of the anastomosis. Age, radiotherapy and preoperative hemoglobin level do not seem to affect flap survival. Smoking was a determining factor in the occurrence of important complications of the flap. Postoperative medical complications occurred in 20% of cases, predominantly cardiac complications. (AU)

Giant Congenital Melanocytic Nevus in a Pediatric Patient: Case Report.

The giant congenital melanocytic nevus is a rare entity with an extremely low incidence that appears at the time of birth and generally involves the dermis but may also affect other skin layers. According to its clinical evolution, the probability of malignancy may vary, so proper follow-up is essential for potential management. There is no consensus in the literature about the greater benefit of surgical versus nonsurgical management. In this case report, we present the surgical management of a school-aged patient using dermal substitutes and skin grafts, subjectively obtaining an improvement in his quality of life.