Tratamiento quirúrgico de las úlceras por presión sacras con colgajo miocutáneo de gluteus maximus por deslizamiento en V-Y: Técnica quirúrgica / Surgical treatment of sacral pressure ulcers with gluteus maximus myocutaneous flap due to V-Y sliding: surgical technique

Resumen Introducción: La úlcera por presión más frecuente es la sacra. Si compromete el hueso puede provocar osteomielitis por lo que requiere aseo quirúrgico y colgajo miocutáneo de gluteus maximus por deslizamiento en V-Y. Materiales y Método: En el servicio de cirugía plástica del hospital del Salvador entre 2011 y 2020 se han operado 82 pacientes con ulceras sacras grado 4 que requirieron cobertura con colgajo miocutáneo de gluteus maximus en V-Y. De ellas se analizaron los últimos 37 pacientes. Resultados De los 37 pacientes, 12 fueron mujeres, 25 hombres, 17 parapléjicos, 12 tetrapléjicos y 8 deambulaban. 6 pacientes presentaron COVID-19. 24 fueron bilaterales y 13 unilaterales. Los colgajos cicatrizaron bien en 30 pacientes. Las complicaciones fueron de 16% consistente en 2 hematomas, 2 dehiscencias, 2 celulitis y 1 seroma, todas resueltas sin problemas. Seguimiento de entre 3 y 6 meses. Discusión El tratamiento quirúrgico con colgajo miocutáneo de gluteus maximus en V-Y, aparte de aportar volumen para ocluir la úlcera, aporta irrigación excelente con oxígeno, nutrientes y antibióticos que aseguran una óptima cicatrización. Dependiendo del diámetro de la úlcera el colgajo puede ser uni o bilateral. Dado lo complejo del tratamiento, en general, el porcentaje de complicaciones de 16% se considera bajo. Conclusión: El tratamiento quirúrgico de las úlceras por presión sacras con colgajos miocutáneos deslizantes de gluteus maximus ha sido exitoso con buenos resultados quirúrgicos con buen flujo sanguíneo y buena evolución.

Introduction: Pressure sores are the result of the compression of soft tissues in the prominent bones areas, mainly in patients without movement. If the depth of the ulcer compromises the sacral bone, the treatment will be the gluteus maximus myocutaneous flap in V-Y. Materials and Method: In the plastic surgery service of the hospital del Salvador 82 patients with sacral pressure sores grade 4 were operated on between 2011 and 2020 with gluteus maximus myocutaneous V-Y flap. The last 37 patients were analyzed. Results: With this treatment the flaps were doing well in all cases with good blood supply. Complications: dehiscence: 2 patients, cellulitis: 2 patients, hematoma: 2 patients and seroma: 1 patient. The overall complication was 16%. Follow up between three and six months. Discussion: The most important part in pressure sores is their prevention. When the ulcer is in prominent parts of the body, the sore, could be in different grades of depth. The classification of them is in grades 1: erythema, 2: subcutaneous tissue. These two grades are solved with conservative treatment. When the ulcers are in grade 3 or 4, and with little ulcer in the skin but with damage of the deep plane, the treatment will be with surgery. In our casuistic the most frequent pressure sore is in the sacrum treated with gluteus maximus sliding myocutaneous flap in V-Y. With this treatment the flaps were doing well in all cases with good blood supply. The complications of 16% were considered low. Conclusion: The sliding gluteus Maximus myocutaneous flap in V-Y for treatment for sacral pressures sores have been successful for our patients.

Retalho miocutâneo inferior pediculado do músculo trapézio nas reconstruções após cirurgias oncológicas de cabeça e pescoço, e tórax / Lower trapezius myocutaneous pedicle flap in head, neck, and chest reconstructions after cancer surgeries

INTRODUÇÃO: Revisão da literatura sobre o retalho miocutâneo inferior do músculo trapézio, apresentando suas vantagens, técnica cirúrgica e complicações. MÉTODOS: Estudo de 19 casos tratados no INCA, através de técnica específica, e comparação dos dados com a literatura internacional. RESULTADOS: Todas as reconstruções atingiram seus objetivos, com correção dos defeitos em partes moles e pele. O efeito estético foi considerado bom pelos pacientes e pela equipe médica. Foi observada uma taxa de 21% de complicações. Não houve necrose ou infecção nos retalhos. Em relação às funções, 89,5% apresentaram função motora preservada e 10,5%, déficit funcional por acometimento tumoral do nervo acessório. CONCLUSÃO: A despeito do aprimoramento contínuo das técnicas microcirúrgicas, os retalhos miocutâneos pediculados ainda encontram indicações nas reconstruções após ressecções oncológicas alargadas. O retalho miocutâneo inferior do músculo trapézio é uma alternativa segura e aplicável para as reconstruções de partes moles das regiões cervicais lateral e posterior, da região lateral da cabeça, da região do ombro e para as regiões paraespinhal superior e paraescapulares.

INTRODUCTION: In this article, we present a literature review on the lower myocutaneous trapezius flap, and report its advantages, surgical technique, and complications. METHODS: We studied 19 patients treated at INCA with a specific technique, and compared the outcomes with those reported in the international literature. RESULTS: All reconstructions achieved the procedural objectives, and the defects of soft tissues and skin were repaired. The aesthetic outcome was considered satisfactory by the patients and medical staff. The rate of complications was 21%. No necrosis or signs of infection were detected in the flaps. Concerning the functions, 89.5% of patients preserved their motor function, whereas reduced functional movements were observed in 10.5% of the patients due to tumor invasion to the accessory nerve. CONCLUSIONS: Despite the continuous advancements in microsurgical techniques, pedicle myocutaneous flaps are still indicated for reconstruction procedures after extended cancer resections. The use of the lower trapezius myocutaneous flap is safe and represents a suitable option for the reconstruction of soft tissues of the lateral and posterior cervical regions, side of the head, shoulder, and upper paravertebral and parascapular regions.