Chertif, Costache; Georgescu, Alexandru Vasile
December 2009
Clujul Medical;Dec2009, Vol. 82 Issue 4, p591
Academic Journal
The surgery of the tissue defects represented a cornerstone for the surgeons, leading to the development of the most diverse methods for solving them. The last discoveries have been the well-known perforator flaps used as local, regional or free flaps. The paper demonstrates the advantages of the perforator flaps in well-selected cases, both as local/regional flaps for covering small and medium-sized tissue defects and free perforator flaps for covering the extended defects at the level of the functional zones of the forearm and hand. The authors present 100 patients with defects of the forearm and hand who have been treated between January 2003 - December 2008. The size of the defect was as on the average 16/10 cm. The perforator flaps used have been: 76 cases of regional pedicled or local transposition perforator flaps (76%) and 24 free perforator flaps (24%). The duration of the operation was between 4 and 7:30 hours for the free transfers and 2 hours for the local/regional flaps. An adequate covering was achieved in all cases. The postoperative follow-up was between 6 months and 3 years. In the cases in which regional pedicled or local transposition perforator flaps were used, the results were very good in 70 cases (92,1 %); in 6 cases (7,9%) minor complications appeared, with congestions and minimum necroses, but with healing by conservatory treatment. Regarding the free perforator flaps, the evolution was good in 18 cases (75%); in 6 cases (25%), a venous thrombosis occurred 8 hours postsurgery, which required a new intervention with a good evolution in 5 cases, but with a complete necrose in one case (4,2%). So, the general success rate in free perforator flaps was 95,8% (23 out of 24 flaps). In conclusion, the local/regional perforator flaps can be successfully used to cover the small and medium-sized defects by reducing the morbidity of the donor site, using the same operative field, replacing the destroyed tissue with similar tissue, avoiding the use of the main vascular axes. The free perforator flaps offer a larger amount of tissue, being indicated in larger defects of the forearm or of the hand, and especially on functional zones.


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