Klinički aspekti rekonstrukcije distalne trećine potkolenice fasciokutanim režnjem baziranim na perforatorima peronealne arterije

  • Zoran Terzić Clinic for Plastic Surgery, Clinical Centar of Montenegro, Podgorica, Montenegro
  • Boban Djordjević Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defense, Belgrade, Serbia
DOI: https://doi.org/10.2298/1880
Ključne reči: reconstructive surgical procedures||, ||hirurgija, rekonstruktivna, procedure, lower extremity||, ||potkolenica, surgical flaps||, ||režnjevi, hirurški, recovery of function||, ||funkcija, povratak,

Sažetak


Uvod/Cilj. Fasciokuatni režnjevi su režnjevi koji u svom sastavu imaju kožu, potkožni sloj i fasciju, a bazirani su na septokutanom sistemu krvnih sudova. Imaju niz karakteristika koje im daju prednost kod velikog broja povređenih, a posebno u zbrinjavanju defekata na ekstremitetima. Cilj ove studije bila je klinička analiza rezultata operativnog hirurškog lečenja bolesnika kod kojih su korišćeni reverzni režnjevi potkolenice bazirani na perforatorima a. peroneae. Metode. Ova prospektivna studija sprovedena je na 22 bolesnika sa defektom tkiva na zadnjoj strani donje trećine potkolenice i stopala kod kojih su urađene preoperativno standardne dijagnostičke analize i priprema bolesnika za spinalnu anesteziju. U operativnom postupku markirano je mesto davajuće regije sa budućim režnjem i pripadajućom vaskularnom peteljkom. Režanj je ispreparisan, rotiran i postavljen na mesto defekta uz predhodnu pripremu primajuće regije shodno hiruškim principima. Rezultati. U ovom kliničkom ispitivanju dominirali su bolesnici muškog pola, 19 (86%), dok je žena bilo 3 (14%). Najveća učestalost defekata, 14 (63%), bila je u starosnoj grupi od 30–50 godina, tj. kod radno sposobnih ljudi. Trauma, 16 (72%), bila je najčešći razlog za operativno liječenje. Defekt se najčešće nalazio na distalnoj trećini potkolenice, 5 (22%), medijalnom maleolusu, 4 (18%), dorzumu stopala 3 (13%) i peti 4 (18%). Broj primijenjenih režnjeva, 18 (81%), u toku kliničkog rada bio je statistički značajniji (p < 0,05) nego broj primijenjenih režnjava zajedno sa autotransplantatom kože, 4 (19%). U toku praćenja primenjenih režnjeva bilo je 6 (27,2%) ranih komplikacija i 2 (9%) kasne što iznosi ukupno 36,2% komplikacija na primenjenim režnjevima, od kojih je samo jedan bio izgubljen. Zaključak. Primena reverzibilnog režnja baziranog na a. suralis superficialis medianae je opravdana zbog velikog procenta (95,5%) očuvanih režnjeva. Funkcionalni oporavak kod povreda u predelu Ahilove tetive pri primeni fasciokutanog režnja bio je efikasan. Dobijeni rezultati mogu biti višestruko korisni u plastičnoj hirurgiji radi optimalnije i češće upotrebe ovoga režnja u različitim rekonstruktivnim hirurškim zahvatima.

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Objavljeno
2015/04/21
Broj časopisa
Vol. 71 Br. 1 (2014)
Rubrika
Originalni članak