Epidemiological Profile of Victim Patients of Facial Canine and Human Bites in a Public Hospital.

INTRODUCTION: Bites are among the most common types of trauma to which humans are exposed. The possibility of disfiguring lesions and the transmission of infectious diseases with high morbidity make this trauma a public health problem. METHOD: This was a retrospective, descriptive study that analyzed the medical records of patients treated at the Emergency Unit of the Plastic Surgery Service of the Asa Norte Regional Hospital from March 2019 to March 2020. The variables analyzed included age, sex, origin, time interval from aggression to hospital care, aggressor agent, wound site, lesion characteristics, and treatment. RESULTS: A total of 103 patients with a mean age of 25 years were evaluated. Most patients were male (57.3%), and 73.8% were from the Federal District. The most common type of treatment was direct suturing in 77.7% of cases, followed by local flaps (15.5%) or grafts (4.9%). There were no deaths or infections reported. CONCLUSION: The predominant profile of a facial bite victim is a young male adult living in the Federal District, bitten by a canine and treated with direct sutures. Adequate treatment for animal bites should include prevention of infection, such as rabies and tetanus, as well as primary wound closure for achieving a better prognosis and satisfactory esthetics for the patient.

What Is the Impact of Residual Obesity on the Risk for Postoperative Body-Contouring Surgery Complications in Postbariatric Patients?

BACKGROUND: There are an increasing number of patients presenting for plastic surgery after massive weight loss, and many of these patients have residual obesity that may compromise outcomes. The impact of residual obesity on the development of postoperative complications in postbariatric patients undergoing plastic surgery procedures is unclear. METHODS: We report the outcomes of 207 patients who underwent plastic surgery following RYGB from January 2011 to December 2018. RESULTS: Two hundred and seven patients (196 females, 11 males) with a mean age of 42 years underwent 335 separate operations. The average BMI at the time of plastic surgery was 27.43 kg/m2. The average weight loss was 47.08 kg. The prevalence of comorbidities was 26.6% and the most important presurgery comorbidities were arterial hypertension (10.1%) and diabetes mellitus (4.8%). Of the 207 patients who underwent surgery, 78.3% (168/207) underwent abdominoplasty and 45.0% underwent mammoplasty. The overall rate of complications was 27.5%. The prevalence of postoperative complications was not significantly different between patients with a BMI ≥ 30 kg/m2 and patients with a BMI < 30 kg/m2 (33.3% vs 25.9%, respectively; p = 0.344). CONCLUSION: In this group of patients, with specified anthropometric and clinical profiles, the residual obesity did not influence the incidence of postoperative complications in postbariatric patients after plastic surgery.

Pioderma gangrenoso em dorso de mão pós-trauma / Pyoderma gangrenosum after trauma to the dorsum of the hand

Introdução: A gangrena pós-operatória de Cullen, também denominada de pioderma gangrenoso (PG) ou abscesso neutrofílico estéril, pelo fato das lesões cutâneas não conterem micro-organismos patogênicos teve sua primeira aparição na literatura médica no ano de 1924, pelo relato feito por Cullen, segundo Schofer e Baur. Mais tarde Brusting et al., em 1930, acrescentaram maiores detalhes a descrição inicial. Objetivo: Relatar um caso raro de pioderma gangrenoso (PG) em extremidades de membros desencadeado por um trauma contuso em dorso de mão. Discussão: O exame histopatológico do PG não é diagnóstico, portanto, a elucidação do quadro se baseia em evidências clínicas. A apresentação clínica é variável: a bolhosa, pustulosa e vegetante. Outras formas raras incluem o PG em locais de patergia (20-30%), periostomal, dorso da mão, PG maligno ou da cabeça e pescoço, multisistêmico e paraneoplásico. Conclusão: O aparecimento do PG é de início súbito e raro em dorso de mão. É importante classificar sua forma clínica, estabelecer associações com patologias de base. A diversidade de drogas para a terapêutica demonstra a dificuldade de padronização de tratamento com variadas respostas, que pode ser empírico e evitar abordagem cirúrgica precoce.

Introduction: Cullen's postoperative gangrene, also called pyoderma gangrenosum (PG) or sterile neutrophilic abscess, was first described in the medical literature by Cullen in 1924. Later Brusting et al., in 1930, described PG in more detail. Objective: To report a rare case of pyoderma gangrenosum (PG) in an extraneous limb that was triggered by blunt trauma to the dorsum of the hand. Discussion: A histopathological exam is not sufficient to diagnose PG, Therefore, a PG diagnosis is based on clinical evidence. The clinical presentation is variable and includes rare bullous, pustular and vegetative forms. Other rare forms of PG occur at sites of pathergy (20- 30%), periostomal skin, the dorsum of the hand, the head and neck. PG can also be multisystemic and paraneoplastic. Conclusion: The appearance of sudden-onset PG is rare in the dorsum of the hand. It is important to classify PG's clinical forms, and to establish associations between PG and underlying pathologies. It is also very important to avoid surgery during early PG. The many drugs used to treat PG, and the multiple patient responses, demonstrate the difficulty of standardizing treatment. Physicians may have to use an empirical approach to select the appropriate drug for each patient.

Quality of life and predictive factors for complications in patients undergoing abdominoplasty after gastric bypass: A retrospective cohort.

BACKGROUND: Obesity is a major health risk factor associated with medical complications, such as cardiovascular disease, that may compromise outcomes. Furthermore, obesity may lead to difficulties in daily life, altering the quality of life and generating psychological disorders such as devalued self-image and depression. OBJECTIVES: This study evaluated the quality of life and predictive factors of postoperative complications in patients who underwent abdominoplasty after Roux-en-Y gastric bypass. SETTING: Bariatric and postbariatric center, North Wing Regional Hospital, Brasília, Brazil. METHODS: Data were analyzed from a prospective registry of postbariatric patients who underwent abdominoplasty from January 2011 to December 2016. Variables examined included age, sex, body mass index (BMI), complications, and comorbidities. Multivariate analyses were performed to assess outcome measures. The quality-of-life assessment was measured with the Moorehead-Ardelt quality-of-life questionnaire. RESULTS: One hundred and seven postbariatric patients were included. The mean age of the patients was 41 years. BMI at the time of abdominoplasty (current BMI) was 27.6 ± 3.7 kg/m2, and the average weight loss before abdominoplasty was 47.7 ± 17.3 kg. Pre-weight loss BMI (max BMI) was 45.5 ± 7.6 kg/m2, and ∆BMI was 18.6 ± 9.3 kg/m2. The overall rate of complications was 23.4%. Among the studied factors in the multivariate analysis, amount of removed tissue in the abdomen >2000 g, ∆BMI >20 kg/m2, and age >40 years significantly increased the rates of postoperative complications. In our study, abdominoplasty improved the quality of life of patients (mean quality-of-life scores, 2.1 ± 0.9). CONCLUSION: The amount of removed tissue in the abdomen, ∆BMI >20 kg/m2, and age >40 years led to significantly more complications in patients undergoing abdominoplasty after gastroplasty. In addition, this study demonstrated that abdominoplasty should be proposed to patients with massive weight loss to improve quality of life.

What Is the Impact of Comorbidities on the Risk for Postoperative Body-Contouring Surgery Complications in Postbariatric Patients?

BACKGROUND: There is an increasing number of patients presenting after massive weight loss for plastic surgery, and many of these patients have residual diseases that may compromise outcomes. This study aims to evaluate the impact of comorbidities on the development of postoperative complications in postbariatric patients undergoing plastic surgery procedures at the Federal District North Wing Regional Hospital, Brasília, Brazil. METHODS: Descriptive, analytical, and prospective study was performed on patients who underwent plastic surgery following RYGB from January 2011 to December 2016. Measures included BMI (body mass index) before RYGB and before plastic surgery, medical complications and comorbidities. RESULTS: One hundred thirty-nine patients (130 female, 9 male) with a mean age of 41 years underwent 233 separate operations. The average BMI at the time of plastic surgery was 27.44 kg/m2. The average weight loss was 47.02 kg, and the mean pre-weight-loss BMI (max BMI) was 45.17 kg/m2. The most important pre-plastic comorbidities were arterial hypertension (11.5%), degenerative arthropathy (5.4%), diabetes mellitus (5.0%), and metabolic syndrome (4.3%). Of the 139 patients operated upon, 76.97% underwent abdominoplasty followed by mammoplasty (42.46%). The overall rate of complications was 26.65%. Initially, on univariate regression analyses, comorbidities influenced the development of postoperative complications. However, after multiple logistic regression, the most important comorbidities failed to predict an increased risk of complications. CONCLUSION: In this group of patients, with these anthropometric and clinical profiles, the most important comorbidities (diabetes, arterial hypertension, and metabolic syndrome) failed to influence the incidence of postoperative complications in postbariatric patients after plastic surgery.

Abdominoplastia em pacientes pós-bariátricos: perfil antropométrico, comorbidades e complicações / Abdominoplasty in gastric bypass patients: anthropometric profile, comorbidities, and complications

Introdução: Os pacientes submetidos à gastroplastia apresentam importante perda de peso e a cirurgia plástica representa um importante meio de tratamento do excesso de pele. Método: Estudo prospectivo foi realizado em pacientes submetidos à abdominoplastia pós-gastroplastia no período de janeiro de 2011 a dezembro de 2016 em hospital público. As variáveis analisadas foram: IMC (Índice de Massa Corporal) antes da gastroplastia e antes da cirurgia plástica, perda de peso, peso do retalho retirado, comorbidades e complicações. Resultados: 107 pacientes que realizaram abdominoplastia foram incluídos. Média de idade foi 41 anos. O IMC médio antes da cirurgia plástica foi 27,6 ± 3,7 Kg/m2. Perda de peso médio foi 47,7 ± 17,3 Kg. O IMC máximo antes da gastroplastia foi 45,5 ± 7,5 Kg/m2 e o IMC foi 18,6 ± 9,3 Kg/m2. Comorbidades presentes antes da plástica foram: hipertensão arterial (11,1%), artropatia (4,6%), diabete melito (5,6%) e síndrome metabólica (5,6%). Catorze (13,1%) pacientes realizaram herniorrafia durante a abdominoplastia. A taxa de complicações foi 31,5%. O peso antes da gastroplastia, IMC antes da gastroplastia, perda de peso médio, comorbidades, peso do retalho do abdome e IMC > 20Kg/m2 foram fatores associados significativamente a complicações pós-operatórias. Conclusões: A gastroplastia em Y de Roux foi uma terapêutica efetiva na resolução de comorbidades em obesos. Comorbidades, peso antes da gastroplastia, perda de peso médio, quantidade de tecido retirado do abdome e IMC > 20Kg/m2 levaram significativamente a mais complicações em pacientes pósbariátricos submetidos à abdominoplastia. A cirurgia plástica é importante no cuidado integral ao paciente obeso e otimizou os resultados alcançados com a cirurgia bariátrica.

Introduction: Patients who undergo vertical-banded gastroplasty- Roux-en-Y gastric bypass (VBG-RYGB) have significant weight loss, and abdominoplasty (AP) is an effective corrective surgery for removing excess skin. Methods: A prospective study conducted from January 2011 to December 2016 in a public hospital evaluated patients who underwent AP after VBG-RYGB. The analyzed variables were body mass index (BMI) before VBG-RYGB, BMI before AP, weight loss, weight of the excised abdominal flap, comorbidities, and complications. Results: For this study, 107 patients who underwent AP were included. The patients' mean age was 41 years; BMI before AP, 27.6 ± 3.7 kg/m2; and mean weight loss, 47.7 ± 17.3 kg. The maximum BMI before bariatric surgery was 45.5 ± 7.5 kg/m2, and the difference between the maximum BMI before VBG-RYGB and before corrective surgery was 18.6 ± 9.3 kg/m2. The comorbidities observed before VBG-RYGB were arterial hypertension (11.1%), arthropathy (4.6%), diabetes mellitus (5.6%), and metabolic syndrome (5.6%). Fourteen patients (13.1%) underwent herniorrhaphy during AP. The overall complication rate was 31.5%. Weight before VBGRYGB, BMI before VBG-RYGB, mean weight loss, comorbidities, abdominal flap weight, and BMI of >20 kg/m2 were significantly associated with postoperative complications. Conclusions: VBGRYGB was an effective approach to reduce comorbidities in obese patients. Comorbidities, weight before VBG-RYGB, mean weight loss, amount of tissue removed from the abdomen, and BMI of >20 kg/m2 significantly increased the complication rate in the gastric bypass patients who underwent AP. Furthermore, AP is fundamental for the comprehensive care of obese patients and has optimized the results achieved with VBG-RYGB.

Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery.

OBJECTIVE: to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. METHODS: we conducted a prospective, descriptive and analytical study of patients submitted to Roux-en-Y gastroplasty, and subsequently to plastic surgery, from January 2011 to December 2016. We assessed body mass index before gastroplasty and after surgery plastic surgery, postoperative complications and comorbidities. RESULTS: we studied 139 patients (130 women and nine men), with a mean age of 41 years, who underwent 233 operations. The mean BMI at the time of plastic surgery was 27.44kg/m2. The mean weight loss was 47.02kg and the mean maximum BMI was 45.17kg/m2. The mean time between bariatric surgery and plastic surgery was 42 months. The most important co-morbidities before plastic surgery were arterial hypertension (11.5%), arthropathy (5.4%), diabetes mellitus (5%) and metabolic syndrome (4.3%) (p<0.01). Of the 139 patients operated on, 76.97% underwent abdominoplasty followed by mammoplasty (42.46%), rhytidoplasty (17.27%) and brachioplasty (13.67%). Fourteen (13.08%) patients underwent herniorrhaphy combined with abdominoplasty. We performed anchor abdominoplasty in 19.42%. The rate of postoperative complications was 26.65%. CONCLUSION: the epidemiological profile of post-bariatric patients who underwent plastic surgery was similar to that reported in the literature, except for the low rate of associated surgeries and postoperative complications. Plastic surgery in post-bariatric patients has led to an improvement in the quality of life in most of these patients.

Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery / Perfil antropométrico e clínico de pacientes pós-bariátricos submetidos a procedimentos em cirurgia plástica

ABSTRACT Objective: to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. Methods: we conducted a prospective, descriptive and analytical study of patients submitted to Roux-en-Y gastroplasty, and subsequently to plastic surgery, from January 2011 to December 2016. We assessed body mass index before gastroplasty and after surgery plastic surgery, postoperative complications and comorbidities. Results: we studied 139 patients (130 women and nine men), with a mean age of 41 years, who underwent 233 operations. The mean BMI at the time of plastic surgery was 27.44kg/m2. The mean weight loss was 47.02kg and the mean maximum BMI was 45.17kg/m2. The mean time between bariatric surgery and plastic surgery was 42 months. The most important co-morbidities before plastic surgery were arterial hypertension (11.5%), arthropathy (5.4%), diabetes mellitus (5%) and metabolic syndrome (4.3%) (p<0.01). Of the 139 patients operated on, 76.97% underwent abdominoplasty followed by mammoplasty (42.46%), rhytidoplasty (17.27%) and brachioplasty (13.67%). Fourteen (13.08%) patients underwent herniorrhaphy combined with abdominoplasty. We performed anchor abdominoplasty in 19.42%. The rate of postoperative complications was 26.65%. Conclusion: the epidemiological profile of post-bariatric patients who underwent plastic surgery was similar to that reported in the literature, except for the low rate of associated surgeries and postoperative complications. Plastic surgery in post-bariatric patients has led to an improvement in the quality of life in most of these patients.

RESUMO Objetivo: avaliar o perfil de pacientes submetidos à cirurgia plástica pós-bariátrica no Hospital Regional da Asa Norte, Brasília, DF. Métodos: estudo prospectivo, descritivo e analítico de pacientes submetidos à gastroplastia em Y- Roux e, posteriormente, à cirurgia plástica, no período de janeiro de 2011 a dezembro de 2016. Foram avaliados o índice de massa corporal antes da gastroplastia e depois da cirurgia plástica, as complicações pós-operatórias e as comorbidades. Resultados: foram estudados 139 pacientes (130 mulheres e nove homens) com média de idade de 41 anos e submetidos a 233 operações. O IMC médio no momento da cirurgia plástica foi de 27,44Kg/m2. A média de perda de peso foi de 47,02Kg e a média de IMC máximo foi de 45,17Kg/m2. O tempo médio entre a cirurgia bariátrica e a cirurgia plástica foi de 42 meses. As comorbidades antes da cirurgia plástica mais importantes foram: hipertensão arterial (11,5%), artropatia (5,4%), diabetes mellitus (5%) e síndrome metabólica (4,3%) (p<0,01). Dos 139 pacientes operados, 76,97% foram submetidos à abdominoplastia seguida de mamoplastia (42,46%), ritidoplastia (17,27%) e braquioplastia (13,67%). Quatorze (13,08%) pacientes foram submetidos à herniorrafia combinada à abdominoplastia. Abdominoplastia em âncora foi feita em 19,42%. A taxa de complicações pós-operatórias foi de 26,65%. Conclusão: o perfil epidemiológico dos pacientes pós-bariátricos que foram submetidos a cirurgia plástica foi semelhante ao relatado na literatura, exceto pela baixa taxa de cirurgias associadas e complicações pós-operatórias. A cirurgia plástica nos pacientes pós-bariátricos gerou uma melhora da qualidade de vida na maioria desses pacientes.

Reconstruction of soft-tissue lesions of the foot with the use of the medial plantar flap.

OBJECTIVE: To study use of the medial plantar flap for reconstruction of the heel and foot. METHOD: The authors share their clinical experience with the use of the medial plantar artery flap for coverage of tissue defects around the foot and heel after trauma. Twelve cases of medial plantar artery flap performed from January 2001 to December 2013 were included. RESULTS: Of the 12 patients, ten were male and two were female. The indications were traumatic loss of the heel pad in ten cases and the dorsal foot in two cases. All the flaps healed uneventfully without major complications, except one case with partial flap loss. The donor site was covered with a split-thickness skin graft. The flaps had slightly inferior protective sensation compared with the normal side. CONCLUSION: From these results, the authors suggest that the medial plantar artery flap is a good addition to the existing armamentarium for coverage of the foot and heel. It is versatile flap that can cover defects on the heel, over the Achilles tendon and plantar surface, as well as the dorsal foot. It provides tissue to the plantar skin with a similar texture and intact protective sensation.

OBJETIVO: Estudar casos de retalho plantar medial na reconstrução do calcanhar e do pé. MÉTODO: Os autores apresentam sua experiência com o uso do retalho baseado na artéria plantar medial para cobertura de defeitos teciduais no pé, especialmente do calcanhar. Doze retalhos da artéria plantar medial, feitos entre janeiro de 2001 e dezembro de 2013, foram incluídos. RESULTADOS: Dos 12 pacientes, dez eram homens e duas mulheres. As indicações foram perda traumática do coxim do calcanhar em dez pacientes e dorso do pé em dois casos. Todos os retalhos cicatrizaram sem maiores complicações, exceto um caso com perda parcial. A área doadora foi coberta com enxerto de pele parcial. Os retalhos apresentaram uma sensibilidade protetora levemente inferior ao lado normal. CONCLUSÃO: De acordo com os resultados, o retalho plantar medial é uma boa opção para cobertura do pé, especialmente da região do calcanhar. A versatilidade do retalho permite a cobertura de defeitos no calcanhar, sobre o tendão de Aquiles e apoio plantar, assim como o dorso do pé. Esse retalho confere para região plantar uma pele de textura similar e sensibilidade protetora intacta.

Retalho plantar medial de fluxo retrógrado para reconstrução de defeitos de dorso de pé / Retrograde flow medial plantar artery flap reconstruction for defects of the dorsal metatarsophalangeal region

Introdução: As reconstruções complexas da região do pé são planejadas com base nas subunidades anatômicas acometidas e pelo fator etiológico da lesão. Para coberturas de defeitos de dorso de pé, temos várias opções, desde as mais simples como enxertia local e retalhos locais ao acaso e retalhos pediculados locorregionais e as complexas com retalhos livres. Este trabalho tem por objetivo relatar um caso, cuja tática cirúrgica inédita na literatura utilizou um retalho plantar medial de fluxo retrógrado na reconstrução dorso-distais do pé. Sua originalidade consiste na passagem do retalho da planta para o dorso através do primeiro espaço intermetatársico. Métodos: Paciente 20 anos, sexo feminino, vítima de acidente de moto com trauma no pé, com perda de substância de dorso ao nível de 1 ao 5 metatarso, com exposição de osso e tendão. Foi utilizado um retalho plantar medial de fluxo retrógrado, com transposição para o dorso do pé. Resultados: A reconstrução da região distal do antepé e dedos são desafios. Os enxertos não são ideais para defeitos profundos e com exposição de estruturas nobres. Retalhos locais não são acessíveis para defeitos de dedos. E os retalhos livres são bem indicados para defeitos grandes. Os retalhos de fluxo reverso da artéria plantar medial está indicado e consagrado para a região do antepé e alguns autores modificaram para região de dorso do primeiro metatarso. Conclusão: Este retalho se mostra útil também para lesões de dorso de pé por meio dessa nova tática cirúrgica inédita na literatura, com a originalidade da passagem do pedículo da planta para o dorso através do primeiro espaço intermetatársico.

Introduction: Complex reconstructions of the foot region are planned based on the anatomical subunits affected by the etiological factors of lesions. We have several options for covering defects of the back of the feet, from the simpler ones, such as local graft and local flap at random and locoregional pedicled flaps, to the more complex ones, such as free flaps. Here, we report a case in which an unpublished technique using a retrograde flow medial plantar flap in the reconstruction of dorso-distal structures of the foot was used. Its originality consisted in the passage of the flap of the plant to the back through the first intermetatarsal space. Methods: The patient was a 20-year-old woman who had a motorcycle accident, wherein she sustained foot trauma with loss of back substance at the first to fifth metatarsal level, with bone and tendon exposure, and retrograde flow medial plantar flap was used, with transposition to the back of the foot. Results: The reconstruction of the distal region of the forefoot and fingers is a challenge. Grafts are not ideal for deep defects and exposure of noble structures. Local flaps are inaccessible for finger defects. Furthermore, the free flaps are well indicated for large defects. The flaps of the medial plantar artery are indicated and consecrated to the forefoot region, and some authors have modified to the dorsum region of the first metatarsal. Conclusion: This flap is useful for reconstruction of feet with dorsal lesions through this new technique that is unpublished in the literature, with the originality of the passage of the pedicle from the plant to the back through the first intermetatarsal space.

Reconstruction of soft-tissue lesions of the foot with the use of the medial plantar flap / Reconstrução de lesões de partes moles de pé com o uso de retalho plantar medial

ABSTRACT OBJECTIVE: To study use of the medial plantar flap for reconstruction of the heel and foot. METHOD: The authors share their clinical experience with the use of the medial plantar artery flap for coverage of tissue defects around the foot and heel after trauma. Twelve cases of medial plantar artery flap performed from January 2001 to December 2013 were included. RESULTS: Of the 12 patients, ten were male and two were female. The indications were traumatic loss of the heel pad in ten cases and the dorsal foot in two cases. All the flaps healed uneventfully without major complications, except one case with partial flap loss. The donor site was covered with a split-thickness skin graft. The flaps had slightly inferior protective sensation compared with the normal side. CONCLUSION: From these results, the authors suggest that the medial plantar artery flap is a good addition to the existing armamentarium for coverage of the foot and heel. It is versatile flap that can cover defects on the heel, over the Achilles tendon and plantar surface, as well as the dorsal foot. It provides tissue to the plantar skin with a similar texture and intact protective sensation.

RESUMO OBJETIVO: Estudar casos de retalho plantar medial na reconstrução do calcanhar e do pé. MÉTODO: Os autores apresentam sua experiência com o uso do retalho baseado na artéria plantar medial para cobertura de defeitos teciduais no pé, especialmente do calcanhar. Doze retalhos da artéria plantar medial, feitos entre janeiro de 2001 e dezembro de 2013, foram incluídos. RESULTADOS: Dos 12 pacientes, dez eram homens e duas mulheres. As indicações foram perda traumática do coxim do calcanhar em dez pacientes e dorso do pé em dois casos. Todos os retalhos cicatrizaram sem maiores complicações, exceto um caso com perda parcial. A área doadora foi coberta com enxerto de pele parcial. Os retalhos apresentaram uma sensibilidade protetora levemente inferior ao lado normal. CONCLUSÃO: De acordo com os resultados, o retalho plantar medial é uma boa opção para cobertura do pé, especialmente da região do calcanhar. A versatilidade do retalho permite a cobertura de defeitos no calcanhar, sobre o tendão de Aquiles e apoio plantar, assim como o dorso do pé. Esse retalho confere para região plantar uma pele de textura similar e sensibilidade protetora intacta.

Epidemiological profile and treatment of substance losses by trauma to the lower limbs.

OBJECTIVES: to evaluate the epidemiological profile, the surgical treatment and the postoperative results of patients with complex traumatic injuries to the lower limbs. METHODS: we conducted a retrospective study of patients with traumatic complex injuries treated by the Plastic Surgery Service of a regional hospital in Brasília. We analyzed clinical-epidemiological data, type of surgical procedure and functional recovery of the limb after six months of treatment. RESULTS: 119 patients were treated, with a mean age of 29 years, predominantly men (76.4%). Motorcycle accident was responsible for most of the injuries, in 37.8% of cases. The most frequent surgical treatment was skin grafting (62.1%), followed by the fasciocutaneous flap (21.9%), muscular flap (12.6%) and microsurgical flap (3.4%). Six months after completion of the surgical treatment, 35.3% of the patients needed crutches to move, characterizing a delay in limb functional recovery that, however, was significantly related to the presence of fractures, external fixation or bone exposure in the preoperative period. CONCLUSION: the profile of the patient with complex traumatic lower limb injury was a male, motorcycle accident victim, and grafting was the most used treatment. Orthopedic trauma with bone fracture, bone exposure and the presence of external fixator were significantly associated with a higher risk of limb functional impairment, requiring locomotion crutches after six months of treatment.

Epidemiological profile and treatment of substance losses by trauma to the lower limbs / Perfil epidemiológico e tratamento de perdas de substância por trauma em membros inferiores

ABSTRACT Objectives: to evaluate the epidemiological profile, the surgical treatment and the postoperative results of patients with complex traumatic injuries to the lower limbs. Methods: we conducted a retrospective study of patients with traumatic complex injuries treated by the Plastic Surgery Service of a regional hospital in Brasília. We analyzed clinical-epidemiological data, type of surgical procedure and functional recovery of the limb after six months of treatment. Results: 119 patients were treated, with a mean age of 29 years, predominantly men (76.4%). Motorcycle accident was responsible for most of the injuries, in 37.8% of cases. The most frequent surgical treatment was skin grafting (62.1%), followed by the fasciocutaneous flap (21.9%), muscular flap (12.6%) and microsurgical flap (3.4%). Six months after completion of the surgical treatment, 35.3% of the patients needed crutches to move, characterizing a delay in limb functional recovery that, however, was significantly related to the presence of fractures, external fixation or bone exposure in the preoperative period. Conclusion: the profile of the patient with complex traumatic lower limb injury was a male, motorcycle accident victim, and grafting was the most used treatment. Orthopedic trauma with bone fracture, bone exposure and the presence of external fixator were significantly associated with a higher risk of limb functional impairment, requiring locomotion crutches after six months of treatment.

RESUMO Objetivo: avaliar o perfil epidemiológico, o tratamento cirúrgico e os resultados pós-operatórios de pacientes com feridas complexas traumáticas de membros inferiores. Método: estudo retrospectivo dos pacientes com ferimentos complexos traumáticos tratados pelo Serviço de Cirurgia Plástica de um hospital regional de Brasília. Foram analisados os dados clínico-epidemiológicos, o tipo de procedimento cirúrgico e a recuperação funcional do membro após seis meses do tratamento. Resultados: foram tratados 119 pacientes, com média de idade de 29 anos, predominantemente homens (76,4%). O acidente moto ciclístico foi responsável pela maioria das lesões, em 37,8% dos casos. O tratamento cirúrgico mais realizado foi o enxerto de pele (62,1% dos casos), seguido pelo retalho fascio-cutâneo (21,9%), o retalho muscular (12,6%) e o retalho microcirúrgico (3,4%). Seis meses após a conclusão do tratamento cirúrgico, 35,3% dos pacientes necessitavam de muletas para se locomover, caracterizando um atraso na recuperação funcional do membro que, no entanto, estava relacionado significativamente à presença de fratura, de fixador externo ou de exposição óssea no pré-operatório. Conclusão: o perfil do paciente com ferida complexa traumática de membros inferiores foi homem, vítima de acidente motociclístico e o enxerto foi o tratamento mais utilizado. O trauma ortopédico com fratura óssea, exposição óssea e a presença de fixador externo estiveram associados significativamente a um maior risco de prejuízo funcional do membro com necessidade de muletas para locomoção após seis meses de tratamento.

Lower extremity reconstruction: epidemiology, management and outcomes of patients of the Federal District North Wing Regional Hospital.

Objective: to evaluate the management of lower limbs complex traumatic injuries by analyzing their characteristics, types, conduct and evolution, with emphasis on surgical treatment. Methods: we conducted a prospective study of patients treated by Plastic Surgery at a regional hospital of the Federal District during a one-year period. We collected data through serial evaluations and telephone contact records. Results: we studied 40 patients, with a mean age of 25.6 years, predominantly male (62.5%). The most frequent wounds were of the distal third of the lower limb (37.5%). Bone or tendon exposures occurred in 55% had and there was a 35% rate of exposed lower limb fractures. The treatments employed were skin grafting (57.5%), local fasciocutaneous flap (15%), muscle flap (12.5%), cross-leg fasciocutaneous flap, reverse sural flap (12.5%) and microsurgical flap (2.5%). Short-term evaluation showed that 35 patients had excellent or good results (87.5%), four had a regular result (10%), and one had an unsatisfactory result (2.5%). In the long term, of the 18 patients who answered the questionnaire, ten resumed walking, even with support, in the first three months after surgery (55.6%). Conclusion: young men involved in motorcycle accidents during leisure time represented the profile of patients with lower limb trauma requiring surgical reconstruction; the distal third of the leg was the most affected region. Grafting was the most used technique for reconstruction and postoperative functional evaluation showed that, despite complex lesions, most patients evolved with a favorable healing process and successful functional evolution.

Objetivo: avaliar o tratamento de feridas traumáticas complexas de membros inferiores analisando suas características, tipos, condutas e evolução, com ênfase no tratamento cirúrgico. Métodos: estudo prospectivo de pacientes tratados pela Cirurgia Plástica em um hospital regional do Distrito Federal no período de um ano. Os dados foram coletados através de avaliações seriadas e registro de contatos telefônicos. Resultados: foram estudados 40 pacientes com média de idade de 25,6 anos, predominantemente homens (62,5%). As feridas do terço distal do membro inferior foram mais frequentes (37,5%). 55% apresentavam exposições óssea ou tendinosa e 35%, fraturas expostas do membro inferior. O tratamento foi enxerto de pele (57,5%), retalho fascio-cutâneo local (15%), retalho muscular (12,5%), retalho fascio-cutâneo de perna cruzada, retalho sural reverso (12,5%) e retalho microcirúrgico (2,5%). A avaliação em curto prazo evidenciou que 35 pacientes tiveram resultado excelente ou bom (87,5%), quatro tiveram resultado regular (10%), e um teve resultado insatisfatório (2,5%). Em longo prazo, dos 18 pacientes que responderam ao questionário, dez deambularam, mesmo que com apoio, no primeiro trimestre após a cirurgia (55,6%). Conclusâo: nosso estudo mostrou que o perfil dos pacientes com trauma de membros inferiores que necessitaram de reconstrução cirúrgica foi representado por homens jovens, envolvidos em acidentes motociclísticos, durante situação de lazer, sendo o terço distal da perna a região mais acometida. A enxertia foi a técnica mais utilizada para reconstrução e a avaliação funcional pós-operatória demonstrou que, apesar de lesões complexas, a maioria dos pacientes evoluiu com processo de cicatrização favorável e sucesso na evolução funcional.

Lower extremity reconstruction: epidemiology, management and outcomes of patients of the Federal District North Wing Regional Hospital / Reconstrução de membros inferiores: perfil, manejo e evolução dos pacientes do Hospital Regional da Asa Norte do Distrito Federal

ABSTRACT Objective: to evaluate the management of lower limbs complex traumatic injuries by analyzing their characteristics, types, conduct and evolution, with emphasis on surgical treatment. Methods: we conducted a prospective study of patients treated by Plastic Surgery at a regional hospital of the Federal District during a one-year period. We collected data through serial evaluations and telephone contact records. Results: we studied 40 patients, with a mean age of 25.6 years, predominantly male (62.5%). The most frequent wounds were of the distal third of the lower limb (37.5%). Bone or tendon exposures occurred in 55% had and there was a 35% rate of exposed lower limb fractures. The treatments employed were skin grafting (57.5%), local fasciocutaneous flap (15%), muscle flap (12.5%), cross-leg fasciocutaneous flap, reverse sural flap (12.5%) and microsurgical flap (2.5%). Short-term evaluation showed that 35 patients had excellent or good results (87.5%), four had a regular result (10%), and one had an unsatisfactory result (2.5%). In the long term, of the 18 patients who answered the questionnaire, ten resumed walking, even with support, in the first three months after surgery (55.6%). Conclusion: young men involved in motorcycle accidents during leisure time represented the profile of patients with lower limb trauma requiring surgical reconstruction; the distal third of the leg was the most affected region. Grafting was the most used technique for reconstruction and postoperative functional evaluation showed that, despite complex lesions, most patients evolved with a favorable healing process and successful functional evolution.

RESUMO Objetivo: avaliar o tratamento de feridas traumáticas complexas de membros inferiores analisando suas características, tipos, condutas e evolução, com ênfase no tratamento cirúrgico. Métodos: estudo prospectivo de pacientes tratados pela Cirurgia Plástica em um hospital regional do Distrito Federal no período de um ano. Os dados foram coletados através de avaliações seriadas e registro de contatos telefônicos. Resultados: foram estudados 40 pacientes com média de idade de 25,6 anos, predominantemente homens (62,5%). As feridas do terço distal do membro inferior foram mais frequentes (37,5%). 55% apresentavam exposições óssea ou tendinosa e 35%, fraturas expostas do membro inferior. O tratamento foi enxerto de pele (57,5%), retalho fascio-cutâneo local (15%), retalho muscular (12,5%), retalho fascio-cutâneo de perna cruzada, retalho sural reverso (12,5%) e retalho microcirúrgico (2,5%). A avaliação em curto prazo evidenciou que 35 pacientes tiveram resultado excelente ou bom (87,5%), quatro tiveram resultado regular (10%), e um teve resultado insatisfatório (2,5%). Em longo prazo, dos 18 pacientes que responderam ao questionário, dez deambularam, mesmo que com apoio, no primeiro trimestre após a cirurgia (55,6%). Conclusâo: nosso estudo mostrou que o perfil dos pacientes com trauma de membros inferiores que necessitaram de reconstrução cirúrgica foi representado por homens jovens, envolvidos em acidentes motociclísticos, durante situação de lazer, sendo o terço distal da perna a região mais acometida. A enxertia foi a técnica mais utilizada para reconstrução e a avaliação funcional pós-operatória demonstrou que, apesar de lesões complexas, a maioria dos pacientes evoluiu com processo de cicatrização favorável e sucesso na evolução funcional.