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)

Propuesta de manejo en reconstrucción microquirúrgica maxilar: serie de casos / Treatment proposal in microsurgical reconstruction of the maxilla: case series

INTRODUCCIÓN Y OBJETIVO: Para la reconstrucción del maxilar se han descrito múltiples clasificaciones y algoritmos de manejo. Actualmente, el más aceptado es el planteado por Cordeiro y Santamaría. Presentamos nuestra experiencia en reconstrucción microquirúrgica del maxilar con colgajos libres de peroné y ánterolateral de muslo, con el objetivo de que se consideren herramientas de primera elección en la reconstrucción de defectos clasificados como tipo II y III. MATERIAL Y MÉTODO: Estudio retrospectivo descriptivo, serie de casos, en el que presentamos 7 casos clínicos de reconstrucción de maxilar con colgajo libre de peroné y ánterolateral de muslo realizados en el Hospital Universitario de La Samaritana (HUS) en Bogotá, Colombia, entre enero de 2018 y febrero de 2019. RESULTADOS: Para la reconstrucción de los defectos IIa, IIb y IIIa utilizamos el colgajo libre de peroné. En maxilectomías clasificadas como IIIb implementamos el colgajo ánterolateral de muslo quimérico con vasto lateral. La supervivencia de los colgajos fue del 100%. CONCLUSIONES: El colgajo libre de peroné es nuestra principal opción reconstructiva en los defectos por maxilectomías IIa, IIb y IIIa, mientras que el colgajo ánterolateral de muslo quimérico con vasto lateral es nuestro colgajo de elección en defectos tipo IIIb

BACKGROUND AND OBJECTIVE: Multiple classifications and management algorithms have been described for maxillary reconstruction, at the present time, the most widely accepted is described by Cordeiro and Santamaría. We present our experience in microsurgical reconstruction of the maxillary with free flaps retrieved from fibula and anterolateral thigh with the intent to consider it as a first-choice option in the reconstruction of defects classified as type II and III. METHODS: A retrospective, descriptive, case series study of 7 maxillary reconstruction cases with free flap from fibula and anterolateral thigh is described. Database was recollected between January 2018 and February 2019 from Hospital Universitario de La Samaritana (HUS) in Bogotá, Colombia. RESULTS: For the reconstruction of IIa, IIb and IIIa defects, a fibular free flap was used. For maxillectomies classified as IIIb, an anterolateral thigh and vast lateral chimeric free flap was implemented. Survival rate of the free flaps was observed at 100%. CONCLUSIONS: The fibular free flap is our primary reconstructive option in defects by maxillectomy classified as IIa, IIb and IIIa. In defects constituted as IIIb, our choice is an anterolateral thigh and vast lateral chimeric flap

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Optimal Result of One-Stage Secondary Debulking Procedure After Flap Reconstruction of the Ankle.

Skin and soft tissue defect of the ankle usually mandates flap reconstruction; however, bulky flap and difficulty ambulance have been the major disadvantages after flap reconstruction of this area. We used the concept of full-thickness skin graft as a 1-stage method of secondary debulking procedure to achieve both aesthetic and functional results. METHODS: Since January of 2004 to June of 2016, 22 one-stage secondary debulking procedures were performed on 22 patients who had received reconstruction with flaps for ankle defects. Nineteen cases were free myocutaneous flaps, 2 cases were free fasciocutaneous flaps, and 1 case was a distally based sural artery flap. In the operative technique, the full-thickness skin was harvested from the flap and regrafted on the defatted fascia with tie-over dressing. The functional and cosmetic outcomes as well as complications were reviewed. RESULTS: The overall mean follow-up time was 12 months. After the debulking procedure, all of the grafted skins took well. The patients were able to wear their own shoes without difficulty and regained ease of ambulation. The reconstructed area was found to decrease to an average of 28.92% as compared with predebulking area. The reconstructed ankles achieve good symmetry with regard to the contralateral side (P < 0.05). All of the patients were satisfied with the results of the reconstructed ankles. CONCLUSIONS: The 1-stage secondary debulking procedure is a safe and reproducible technique that achieves good functional and aesthetic outcomes after flap reconstruction of the ankle.