Lower Limb Reconstruction - Fasciocutaneous Sural Flap.

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 from 6 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.

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.

Use of oral anticoagulants for the prevention of thromboembolic events in the post-operative period of hip arthroplasty: a systematic review / Uso de anticoagulantes orais para prevenção de eventos tromboembólicos no pós-operatório de artroplastia de quadril: revisão sistemática

ABSTRACT Oral anticoagulants are being used in the postoperative period of hip arthroplasty to prevent of thromboembolic events, create doubts as to the effectiveness of thromboprophylaxis and reduce the risk of hemorrhage. This systematic revision is aimed at evaluating the use of oral anticoagulants in the prevention of thromboembolic events in the postoperative period of patients undergoing hip arthroplasty. Research with descriptors found on PubMed, BVS, and the CAPES portal for medical journal publications from September 2015 to June 2016, from the last ten years (2005-2015), complete, free, and written in Portuguese and in English were the methods used. The results of the studies showed some cases of pulmonary embolism, deep vein thrombosis, and bleeding; even then, the NOACs were effective in preventing thromboembolic events. There is no consensus regarding the prophylaxis method for these events, which is why the challenge is to obtain high levels of prevention while minimizing the adverse effects. The most studied oral anticoagulant was rivaroxaban (67%). The three drugs that were studied have shown to be effective in preventing thromboembolic events, but the best results were obtained with rivaroxaban 10 mg, one tablet daily; treatment duration ranged from 30 to 35 days with oral anticoagulants and from 28 to 42 days with anti-platelet drugs.

RESUMO Os anticoagulantes orais usados no pós-operatório de artroplastia de quadril para prevenção de eventos tromboembólicos geram dúvidas a respeito da efetividade tromboprofilática e da redução de riscos hemorrágicos. Para isso, esta revisão sistemática tem como objetivo avaliar o uso de anticoagulantes orais para prevenção de eventos tromboembólicos no pós-operatório de pacientes submetidos a artroplastia de quadril. Os métodos usados foram pesquisas nas bases de dados indexadas do PubMed, BVS e periódicos da Capes de setembro de 2015 a junho de 2016, dos últimos dez anos, completos, livres e nos idiomas inglês e português. Os resultados apresentaram alguns casos de embolia pulmonar, trombose venosa profunda e sangramentos; apesar disso, os NACOs foram considerados, pelos estudos citados, eficazes na prevenção de eventos tromboembólicos. Os três medicamentos estudados mostraram-se importantes na prevenção de eventos tromboembólicos, mas os melhores resultados profiláticos foram obtidos com Rivaroxaban 10 mg, uma vez ao dia, com duração entre 30 e 35 dias com anticoagulantes orais e 28 a 42 dias com antiagregante plaquetário.

Use of oral anticoagulants for the prevention of thromboembolic events in the post-operative period of hip arthroplasty: a systematic review.

Oral anticoagulants are being used in the postoperative period of hip arthroplasty to prevent of thromboembolic events, create doubts as to the effectiveness of thromboprophylaxis and reduce the risk of hemorrhage. This systematic revision is aimed at evaluating the use of oral anticoagulants in the prevention of thromboembolic events in the postoperative period of patients undergoing hip arthroplasty. Research with descriptors found on PubMed, BVS, and the CAPES portal for medical journal publications from September 2015 to June 2016, from the last ten years (2005-2015), complete, free, and written in Portuguese and in English were the methods used. The results of the studies showed some cases of pulmonary embolism, deep vein thrombosis, and bleeding; even then, the NOACs were effective in preventing thromboembolic events. There is no consensus regarding the prophylaxis method for these events, which is why the challenge is to obtain high levels of prevention while minimizing the adverse effects. The most studied oral anticoagulant was rivaroxaban (67%). The three drugs that were studied have shown to be effective in preventing thromboembolic events, but the best results were obtained with rivaroxaban 10 mg, one tablet daily; treatment duration ranged from 30 to 35 days with oral anticoagulants and from 28 to 42 days with anti-platelet drugs.

Os anticoagulantes orais usados no pós-operatório de artroplastia de quadril para prevenção de eventos tromboembólicos geram dúvidas a respeito da efetividade tromboprofilática e da redução de riscos hemorrágicos. Para isso, esta revisão sistemática tem como objetivo avaliar o uso de anticoagulantes orais para prevenção de eventos tromboembólicos no pós-operatório de pacientes submetidos a artroplastia de quadril. Os métodos usados foram pesquisas nas bases de dados indexadas do PubMed, BVS e periódicos da Capes de setembro de 2015 a junho de 2016, dos últimos dez anos, completos, livres e nos idiomas inglês e português. Os resultados apresentaram alguns casos de embolia pulmonar, trombose venosa profunda e sangramentos; apesar disso, os NACOs foram considerados, pelos estudos citados, eficazes na prevenção de eventos tromboembólicos. Os três medicamentos estudados mostraram-se importantes na prevenção de eventos tromboembólicos, mas os melhores resultados profiláticos foram obtidos com Rivaroxaban 10 mg, uma vez ao dia, com duração entre 30 e 35 dias com anticoagulantes orais e 28 a 42 dias com antiagregante plaquetário.