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El colgajo antebraquial anterior es una excelente área dadora para transferir tejido. A lo largo de los años el colgajo antebraquial libre ha tomado fuerza dado que proporciona la cantidad de tejido a donar, su localización y, por sobre todo, la facilidad de disección, que se necesita para cubrir diferentes defectos en todo el cuerpo. Además, debe optimizar los resultados funcionales y estéticos. El sitio receptor debe cumplir en la medida de lo posible, utilizando colgajos con características similares, restablecer la integridad estructural o la función. Material y métodos. Se han realizado desde marzo 2021 a marzo del corriente año un total de 26 colgajos antebraquial libre. Los pacientes de esta serie fueron 80% hombres y 20% mujeres con un rango de edad de 25 a 73 años. Se utilizó tanto para patologías oncológicas, traumáticas e incluso colgajo de elección en pacientes trans para la creación del falo. Se tuvo en cuenta la utilización de la mano no hábil del paciente para así disminuir los riesgos de secuelas funcionales. Este colgajo aporta buen volumen de isla de piel, su pedículo es constante y confiable. La disección del colgajo, en manos entrenadas, acorta los tiempos quirúrgicos y demostró ser útil en muchísimas zonas receptoras del cuerpo. Resultados. Se logró el aporte de tejido necesario en todas las patologías a tratar, utilizando como zonas receptoras diferentes tipos de pedículos. También se logró un buen resultado tanto estético como funcional, volviendo a dar al paciente una calidad de vida aceptable. Conclusiones. El colgajo antebraquial libre ha demostrado ser útil en diversas patologías a tratar. Buen tegumento, su disección es fácil y accesible para cirujanos reconstructivos que recién comienzan su formación así como para cirujanos ya entrenados. Consta de un pedículo confiable con buen diámetro y longitud, lo cual lo hace aún más verídico para contar como primera opción cuando se lo necesita como colgajo libre.

The anterior antebrachial flap is an excellent donor area for tissue transfer. Over the years the free antebrachial flap has gained strength since it provides the amount of tissue to donate, its location and above all the ease of dissection, which is needed to cover different defects throughout the body. It must also optimize functional and aesthetic results. The receiving site should comply as far as possible, using flaps with similar characteristics, restore structural integrity or function

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Tumoral involvement of the carotid artery may require en-bloc resection in order to achieve a better regional control. Among the carotid reconstruction methods at disposal, autologous tissues appear to be more reliable in cases with high risk of infection and poor tissue healing like in radiated necks. We describe a case of a 55 year old man, who suffered from recurrent squamous cell carcinoma in the neck region, invading the common carotid artery. After en-bloc resection of the tumor together with skin, internal jugular vein, vagus nerve and common carotid artery, carotid reconstruction was performed with a flow-through chimeric flap based on superficial femoral vessels (15 cm). After resection of the tumor, the flap was used to replace the soft tissue defect (23 × 12 cm). Anteromedial thigh skin paddle (8 × 5 cm) and sartorius muscle (12 × 3 cm) were included in the flap. The superficial femoral vessels were reconstructed with 8-mm ringed polytetrafluoroethylene graft interposition. Thanks to an accurate surgical planning and a 2-team approach, the ischemia time of the leg was 42 min and there were no limb ischemia nor pathologic neurological signs after surgery. During the 12-month follow up, no other complication was registered. In our experience, microsurgical carotid reconstruction represents a reliable option with important advantages such as resistance to infection, optimal size matching, and good tissue healing between the irradiated carotid stump and the vascular graft.

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Introducción: El colgajo pediculado realizado con músculo temporal es una opción terapéutica válida para la reconstrucción de defectos de la región facial posterior a una resección quirúrgica, es una alternativa aceptable a los colgajos libres cuando estos no pueden ser utilizados ya sea por el performance status o patología de base de los pacientes a tratar o por no contar con cirujano microvascular. Objetivo: Describir nuestra experiencia en el uso de este colgajo para la reconstrucción de 7 pacientes con defectos de órbita, paladar y mucosa yugal tras la cirugía ablativa de diversas patologías. Materiales y métodos: Revisión retrospectiva de los pacientes del Servicio de Cirugía General del Hospital José Ramon Vidal, Corrientes-Argentina operados en el periodo comprendido desde enero del 2019 hasta enero del 2021.En este lapso, 7 pacientes fueron sometidos a cirugía reconstructiva inmediata con colgajo de músculo temporal en defectos del tercio medio de la región facial. Resultados: Un total de siete pacientes, (4 masculino- 3 femenino), sometidos a cirugía ablativa por presentar patología maligna (6) y patología benigna (1), con una edad media de 60 años. Dos colgajos se utilizaron para defectos de región orbitaria y partes blandas, seis para defectos en la cavidadoral­ en un paciente se emplearon los 2 músculos temporales-. El colgajo fue exitoso en todos los casos, se presentaron complicaciones menores como: dolor postoperatorio, hematoma, trismus, depresión de la zona dadora. Se obtuvo márgenes libres en el total de los procedimientos. Discusión: La cirugía reconstructiva con colgajo pediculado de musculo temporal es una excelente alternativa de colgajo regional con buenos resultados, posee alta tasa de éxito justificada por su buena vascularización. Además, la proximidad del músculo temporal con la región maxilofacial y su inserción contribuyen a obtener un arco de rotación hasta 180° sin comprometersu vitalidad. Es útil para la reconstrucción en un acto quirúrgico, acortando el tiempo intraoperatorio y sin cambios posicionales. Conclusiones: El colgajo de músculo temporal resulta una opción válida a los colgajos libres osteo-mio-cutáneos para defectos mixtos (óseos y de partes blandas) del tercio medio facial luego de la cirugía ablativa, cuando estos últimos no pueden ser implementados teniendo en cuenta varios aspectos como performance estatus de los pacientes, patología de base y necesidad de contar con un cirujano microvascular

Introduction: temporalis muscle vascularized flaps is a valid therapeutic option for reconstruction of defects in facial region after surgical resections. It is an acceptable alternative to free transfer flaps when these cannot be used because of the patient's performance state and base pathologies. Or because of the lack of a microvascular surgeon. Objectives: To describe on experience applying this kind of flaps for the reconstruction or 7 patients, with defects in palate orbit and yugal mucose after resective surgeries for various pathologies. Materials and methods: retrospective revision of patients in the general department, of Jose R Vidal Hospital (Corrientes - Argentina) into underwent surgery during the period between January 2019 ad January 2021. A total of 7 patients underwent immediate reconstructive surgery using a temporalis muscle flap. Results: 7 patients (4 males y 3 female) underwent resective surgery for different malignant (6) and benign (1) with a median age of 60. Two flaps were used for defects of the orbitary region and soft tissue, six for defects of the oral cavity (in one patient both temporalis muscle were used. Te procedure was successful in all cases, and minor complication were present, (post operatory pain, hematoma, trismus, excavation of the donor region) all procedures resulted un surgical margins of lesion of malignancy. Discussion: reconstructive surgery using a vascularized flap of temporalis muscle is an excellent alternative for regional flaps with good results and a high success justified because of its a good irrigation. Besides the proximity between temporalis muscle and the maxillofacial region, possibilities a flap rotation of up to 180 grades without compromising its vitality it is also useful for reconstruction in a single surgery shortening intra-operatory time while avoiding repositioning of the patients during the procedure. Conclusions: Temporalis muscle flaps are valid option to free osteo- mayo- cutaneal flaps for mixed defects (involving bone and soft tissue) of the medium third of facial region after resective surgeries when the latter cannot be carried and because of various aspects little performance status base pathologies and lack of microvascular margin.

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El macizo facial es una región anatómica compleja que alberga órganos sensoriales. El desarrollo de una enfermedad oncológica, así como su tratamiento, causan defectos funcionales y estéticos con un alto costo físico y psíquico para el paciente y su entorno. Es por ello que la reconstrucción representa un reto. Las diferentes posibilidades incluyen prótesis obturatríces, colgajos libres, pediculados o microvascularizados. En este artículo se describirá el colgajo de músculo temporal y se desarrolla un caso clínico de cirugía oncológica maxilar reconstruido mediante éste en un paciente que presenta una lesión exofítica en cuadrante superior derecho, que se extiende sobre el flanco vestibular, reborde alveolar y zona palatina, desde zona de premolares hasta la zona del segundo molar inclusive, impidiéndole usar la prótesis dental. Esta cirugía es una técnica económica, que requiere menor tiempo quirúrgico que otras técnicas, asociándose a poco porcentaje de fracaso y pocas complicaciones post operatorias.

The facial mass is a complex anatomical region that houses sensory organs. The development of an oncologic disease, as well as its treatment, causes functional and esthetic defects with a high physical and psychological cost for the patient and his environment. This is why reconstruction represents a challenge. The different possibilities include obturator-root prostheses, free, pedicled or microvascularized flaps. In this article the temporal muscle flap will be described and a clinical case of maxillary oncologic surgery reconstructed by means of it is developed in a patient who presents an exophytic lesion in the right upper quadrant, which extends over the vestibular flank, alveolar ridge and palatal area, from the premolar area up to and including the second molar area, preventing him from using the dental prosthesis. This surgery is an economical technique that requires less surgical time than other techniques, and is ass

A massa facial é uma região anatômica complexa que abriga órgãos sensoriais. O desenvolvimento de uma doença oncológica, assim como seu tratamento, causa defeitos funcionais e estéticos com alto custo físico e psicológico para o paciente e seu ambiente. A reconstrução é, portanto, um desafio. As diferentes possibilidades incluem as próteses de raiz obturadora, abas livres, pediculadas ou microvascularizadas. Este artigo descreve o retalho muscular temporal e descreve um caso clínico de cirurgia oncológica maxilar reconstruída utilizando-o em um paciente com lesão exofítica no quadrante superior direito, estendendo-se pelo flanco vestibular, rebordo alveolar e área palatina, desde a área do pré-molar até a área do segundo molar inclusive, impedindo-o de utilizar a prótese dentária. Esta cirurgia é uma técnica econômica, que requer menos tempo cirúrgico que outras.

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INTRODUCTION: Microvascular free-flap reconstruction is one of the treatment options after large resection of head and neck neoplasms. The objectives of this study are to identify short-term outcomes and risk factors for flap complication in patients who underwent neoplasms resection of head and neck with microvascular free-flap reconstruction. METHODS: Retrospective study of patients who underwent surgery for head and neck neoplasm with microvascular free-flap reconstruction between January 2014-2020. Complications were studied at 30-days follow-up and divided into medical and flap complications. Factors independently associated with flap complication were analyzed. RESULTS: We included 31 patients (15 men). The mean age was 60 years. Reconstruction was performed with radial-forearm flap in 74% (n=23) and with free-fibula flap in 26% (n=8). Mean surgical time was 420 minutes. Median hospital length of stay was 7 days. Medical complications were of 23%. Minor complications were of 35% and major of 32%. There was no mortality in 30-days follow-up. Flap complications were of 35%. Reintervention was of 29%, surgical site infection of 9%, dehiscence of 29% and flap loss of 9.7%.  Surgical site infection was independently associated with prolonged surgical time (Odds ratio [OR]=1.03, IC95%=0.98-1.04, p=0.02) and body mass index equal to or greater than 30 (OR=1.38, IC95%=0.84-2.26, p=0.04) while flap loss was associated with prolonged surgical time (OR=1.02, IC95%=0.99-1.04, p=0.01). CONCLUSION: Microsurgical free-flap reconstruction should be considered in our population in patients with large head and neck neoplasms. Preoperative assessment of the risk of postoperative complications is essential before selecting patients for this surgery.

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Vascular arteriovenous malformations originate during the early stages of embryonic development and generally grow progressively, especially during adolescence and pregnancy. Limb salvage using microsurgery is presented, in a patient with an arteriovenous malformation who was initially a candidate for limb amputation. En bloc resection of the arteriovenous malformation of all segments with extended brachial approach and the cutaneous component was performed, with an anterolateral thigh free flap for the lateral reconstruction of the hand.

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INTRODUCTION: Soft-tissue reconstruction of the scalp has traditionally been challenging in oncologic patients. Invasive tumors can compromise the calvarium, necessitating alloplastic cranioplasty. Titanium mesh is the most common alloplastic material, but concerns of compromise of soft-tissue coverage have introduced hesitancy in utilization. The authors aim to identify prognostic factors associated with free-flap failure in the context of underlying titanium mesh in scalp oncology patients. METHODS: A retrospective review (2010-2018) was conducted at a single center examining all patients following oncologic scalp resection who underwent titanium mesh cranioplasty with free-flap reconstruction following surgical excision. Patient demographics, comorbidities, ancillary oncological treatment information were collected. Operative data including flap type, post-operative complications including partial and complete flap failure were collected. RESULTS: A total of 16 patients with 18 concomitant mesh cranioplasty and free-flap reconstructions were identified. The majority of patients were male (68.8%), with an average age of 70.5 years. Free-flap reconstruction included 15 ALT flaps (83.3%), 2 latissimus flaps (11.1%), and one radial forearm flap (5.5%). There were three total flap losses in two patients. Patient demographics and comorbidities were not significant prognostic factors. Additionally, post-operative radiation therapy, ancillary chemotherapy, oncological histology, tumor recurrence, and flap type were not found to be significant. Pre-operative radiotherapy was significantly associated with flap failure (P < 0.05). CONCLUSION: Pre-operative radiotherapy may pose a significant risk for free-flap failure in oncologic patients undergoing scalp reconstruction following mesh cranioplasty. Awareness of associated risk factors ensures better pre-operative counseling and success of these reconstructive modalities and timing of pre-adjuvant treatment.

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O retalho de padrão axial da artéria angular da boca foi a técnica de escolha para fechamento de uma ferida cirúrgica, criada após a ressecção de um tumor cutâneo localizado na região temporal direita de um cão. O retalho foi transposto ao leito receptor com redução de espaço morto em padrão simples contínuo com poliglecaprone 25, e dermorrafia em padrão simples interrompido com nylon 3-0. No pós-operatório imediato foi observado algumas áreas com hematoma, após 12 dias do procedimento cirúrgico apresentou deiscência em dois pontos, sendo tratado pela segunda intenção com sulfadiazina de prata 1% e, alta após 5 dias com fechamento completo da ferida. O laudo histopatológico confirmou mastocitoma canino grau 2 (Patnaik) ou alto grau (Kiupel), foi indicada quimioterapia, porém proprietário não aderiu continuidade ao tratamento. Em conclusão, a utilização do retalho de padrão axial da artéria angular da boca revelou-se eficiente para correção de falhas cutâneas em região temporal.(AU)

The axial pattern flap of the angular artery of the mouth was the technique of choice for surgical wound closure after resection of a cutaneous tumor located in the right temporal region of a dog. The flap was transposed to the receptor bed with reduction of dead space in a continuous simple pattern with polyiglecapone 25, and the dermorrhaphy was performed with a simple pattern interrupted with 3-0 nylon. In the immediate postoperative period, it was observed some areas with hematoma, after 12 days of the surgical procedure, dehiscence was observed in two points, being treated by second intention with 1% sulfadiazine. The patient was discharged after 5 days with complete closure of the wound. The histopathological report confirmed canine mastocytoma grade 2 (Patnaik) or high grade (Kiupel), thus, chemotherapy was indicated, but the owner did not adhere to the treatment. In conclusion, the use of the axial pattern flap of the angular artery of the mouth was efficient for the correction of skin defects in the temporal region.(AU)

Un colgajo de tipo axial de la arteria angular de la boca fue la técnica escogida para cerrar una herida cutánea aguda ocasionada por escisión de un tumor localizado en la región temporal derecha de un perro. Tras realizar la tranposición del colgajo sobre el lecho receptor, el espacio muerto fue reducido con patrón de sutura simple continuo, subcutáneo, utilizando poliglecaprone 25, y la aposición de las bordes cutáneos fue con nylon 3-0 en patrón simple discontinuo. En el pós-operatorio inmediato fue observado hematoma en algunas áreas. Después de doce días hubo dehiscencia en dos puntos, la herida fue cicatrizando por segunda intención con administración de sulfadiazina de plata 1%. Después de cinco días la herida cicatrizó por completo y fue dada el alta. El resultado del histopatológico confirmó mastocitoma canino grado 2 (Patniak) o alto grado (Kiupel), fue recomendado quimioterapia, sin embargo el propietario no accedió al tratamiento. En conclusión, el colgajo de tipo axial de la arteria angular de la boca fue eficiente para corregir el defecto cutáneo en la región temporal.(AU)

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O retalho de padrão axial da artéria angular da boca foi a técnica de escolha para fechamento de uma ferida cirúrgica, criada após a ressecção de um tumor cutâneo localizado na região temporal direita de um cão. O retalho foi transposto ao leito receptor com redução de espaço morto em padrão simples contínuo com poliglecaprone 25, e dermorrafia em padrão simples interrompido com nylon 3-0. No pós-operatório imediato foi observado algumas áreas com hematoma, após 12 dias do procedimento cirúrgico apresentou deiscência em dois pontos, sendo tratado pela segunda intenção com sulfadiazina de prata 1% e, alta após 5 dias com fechamento completo da ferida. O laudo histopatológico confirmou mastocitoma canino grau 2 (Patnaik) ou alto grau (Kiupel), foi indicada quimioterapia, porém proprietário não aderiu continuidade ao tratamento. Em conclusão, a utilização do retalho de padrão axial da artéria angular da boca revelou-se eficiente para correção de falhas cutâneas em região temporal.

The axial pattern flap of the angular artery of the mouth was the technique of choice for surgical wound closure after resection of a cutaneous tumor located in the right temporal region of a dog. The flap was transposed to the receptor bed with reduction of dead space in a continuous simple pattern with polyiglecapone 25, and the dermorrhaphy was performed with a simple pattern interrupted with 3-0 nylon. In the immediate postoperative period, it was observed some areas with hematoma, after 12 days of the surgical procedure, dehiscence was observed in two points, being treated by second intention with 1% sulfadiazine. The patient was discharged after 5 days with complete closure of the wound. The histopathological report confirmed canine mastocytoma grade 2 (Patnaik) or high grade (Kiupel), thus, chemotherapy was indicated, but the owner did not adhere to the treatment. In conclusion, the use of the axial pattern flap of the angular artery of the mouth was efficient for the correction of skin defects in the temporal region.

Un colgajo de tipo axial de la arteria angular de la boca fue la técnica escogida para cerrar una herida cutánea aguda ocasionada por escisión de un tumor localizado en la región temporal derecha de un perro. Tras realizar la tranposición del colgajo sobre el lecho receptor, el espacio muerto fue reducido con patrón de sutura simple continuo, subcutáneo, utilizando poliglecaprone 25, y la aposición de las bordes cutáneos fue con nylon 3-0 en patrón simple discontinuo. En el pós-operatorio inmediato fue observado hematoma en algunas áreas. Después de doce días hubo dehiscencia en dos puntos, la herida fue cicatrizando por segunda intención con administración de sulfadiazina de plata 1%. Después de cinco días la herida cicatrizó por completo y fue dada el alta. El resultado del histopatológico confirmó mastocitoma canino grado 2 (Patniak) o alto grado (Kiupel), fue recomendado quimioterapia, sin embargo el propietario no accedió al tratamiento. En conclusión, el colgajo de tipo axial de la arteria angular de la boca fue eficiente para corregir el defecto cutáneo en la región temporal.

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