Search

BackgroundThe objective of this paper is to evaluate the results after the use of distally-based reverse fasciocutaneous sural flap in the reconstruction of soft-tissue loss around the distal tibia, ankle and foot. Methods37 fasciocutaneous pedicled reverse sural flaps performed between 2008 and 2016 were retrospectively evaluated. Average age of the patients: 49 years (range 8-90). Soft-tissue loss was post-traumatic in 27 cases, 7 cases presented soft tissue defect after pressure sores (two bilateral) and three patients presented skin necrosis secondary to surgical procedure. Defect size averaged 9,6 x 6,7 (15 x 9) cm. ResultsFollow-up averaged 18 months. Complete softtissue defect coverage was achieved in 29 cases. Three flaps had partial necrosis and five suffered completed necrosis, four of them had history of vascular disease.ConclusionsAlthough multiple coverage options have been described for soft-tissue coverage around the distal tibia, ankle and foot, the reverse sural flap is one of the most frequently used procedures to cover these defects. We evaluated 37 reverse sural flaps, achieving good results with low percentage of complications and morbidity., IntroducciónLos traumatismos de alta energía en miembros inferiores se asocian con frecuencia a defectos de partes blandas, y su reconstrucción puede presentarse como una tarea desafiante, siendo en el extremo dista de la pierna y el pie los colgajo de perforantes la mejor opción de cobertura.El motivo de este trabajo es presentar el resultado del tratamiento de lesiones de partes blandas de pierna distal, tobillo y talón utilizando exclusivamente el colgajo de perfotantes fasciocutáneo sural.Material y métodosEntre marzo de 2008 y febrero de 2016 se realizaron en nuestro hospital 37 colgajos fasciocutáneos surales en 35 pacientes. El criterio de inclusión fue todo paciente con defecto tegumentario en tercio distal de tibia y talón con exposición ósea, tendinosa o defecto de la almohadilla plantar.La edad promedio fue de 49,6 años (8-90) con un seguimiento promedio de 18 meses (1-60 meses).ResultadosDe los 37 colgajos realizados 29, incluyendo a aquellos realizados en dos tiempos, no tuvieron complicaciones con buena adaptación local y sin necrosis, 3 presentaron necrosis parcial que fue mejorada con el avance del colgajo o injerto de piel parcial sin mayor necesidad de procedimientos y 5 colgajos presentaron necrosis completa. El tamaño del defecto fue de 9,6 x 6,7 (15 x 9) cm.ConclusiónAunque nuestra serie no es extensa, nuestros resultados son coincidentes con la literatura. Creemos que este colgajo es una alternativa viable para lesiones distales de pierna y pie con un bajo porcentaje de complicaciones y morbilidad en el miembro afectado, y con resultados satisfactorios.

Objectives: To study the perinatal outcome in term oligohydramnios.To compare the mode of delivery in patients with oligohydramnios with the control group (AFI>5). Methods: The study was a prospective study carried out in the department of OBG at K.V.G. Medical College and Hospital, Sullia over a period of 1 year from January 2012 to December 2012. A total of 100 low risk patients of gestational age >37 weeks were studied, of which 50 had an AFI 5 and were included in the study group and 50 had an AFI>5 and were allocated to the control group. The mode of delivery and the perinatal outcome was compared between the two groups. Chi square test was used for statistical analysis. Results: The rate of caesarean section was 68% in the group with oligohydramnios and 28% in the group with normal liquor volume. The difference was significant. The incidence of intrauterine growth restriction was significantly high in the study group (48%) as compared to the control group (22%). The prevalence of thick meconium (8% vs 6%) and non reassuring non stress test (12% vs 8%) was not significantly different in between the two groups. The fetal outcome as assessed by the apgar score and the neonatal intensive care unit admission rate (14% vs 4%) were not different in between the two groups. There were no perinatal deaths in either of the two groups. Conclusion: Isolated oligohydramnios in the absence of any other maternal or fetal complicating factor is not found to adversely affect the fetal outcome, though the fetal weight may be slightly lower in babies born to mothers with oligohydramnios. The incidence of caesarean section for fetal distress is higher in patients with oligohydramnios.

Objectives: To study the perinatal outcome in term oligohydramnios.To compare the mode of delivery in patients with oligohydramnios with the control group (AFI>5). Methods: The study was a prospective study carried out in the department of OBG at K.V.G. Medical College and Hospital, Sullia over a period of 1 year from January 2012 to December 2012. A total of 100 low risk patients of gestational age >37 weeks were studied, of which 50 had an AFI 5 and were included in the study group and 50 had an AFI>5 and were allocated to the control group. The mode of delivery and the perinatal outcome was compared between the two groups. Chi square test was used for statistical analysis. Results: The rate of caesarean section was 68% in the group with oligohydramnios and 28% in the group with normal liquor volume. The difference was significant. The incidence of intrauterine growth restriction was significantly high in the study group (48%) as compared to the control group (22%). The prevalence of thick meconium (8% vs 6%) and non reassuring non stress test (12% vs 8%) was not significantly different in between the two groups. The fetal outcome as assessed by the apgar score and the neonatal intensive care unit admission rate (14% vs 4%) were not different in between the two groups. There were no perinatal deaths in either of the two groups. Conclusion: Isolated oligohydramnios in the absence of any other maternal or fetal complicating factor is not found to adversely affect the fetal outcome, though the fetal weight may be slightly lower in babies born to mothers with oligohydramnios. The incidence of caesarean section for fetal distress is higher in patients with oligohydramnios.

Background: the objective of this paper is to evaluate the results after the use of distally-based reverse fasciocutaneous sural flap in the reconstruction of soft-tissue loss around the distal tibia, ankle and foot.Methods: twenty fasciocutaneous pedicled reverse sural flaps performed between 2007 and 2013 were retrospectively evaluated. Average age of the patients: 42 years (range 6-79), 14 were male and 5 were female. Soft-tissue loss was post-traumatic in 17 cases (one bilateral) and secondary to oncologic resections in two cases. The series included three diabetic patients, one obese woman, and eight smokers. Ten cases had exposed tendons and ten had bony exposure. Defect size averaged 8.9 x 5.75 cm.Results: Follow-up averaged 16 months. Complete soft-tissue defect coverage was achieved in all 20 cases. Hospital stay averaged 3.15 days. Three flaps had superficial necrosis, one flap suffered necrosis of its distal third, and the lower extremity was amputated in a patient due to persistent osteomyelitis.Conclusions: Although multiple coverage options have been described for soft-tissue coverage around the distal tibia, ankle and foot, the reverse sural flap is one of the most frequently used procedures to cover these defects. We evaluated 20 reverse sural flaps, achieving complete soft-tissue coverage in post-traumatic lesions as well as in those defects resulting from oncologic resections., In­tro­duc­ción: el objetivo de este trabajo es evaluar los resultados obtenidos con la utilización del colgajo fasciocutáneo sural de base distal para la reconstrucción de defectos de partes blandas alrededor de la tibia distal, el tobillo y el pie.Materiales­ y ­Métodos: se evaluaron, en forma retrospectiva, 20 colgajos pediculados fasciocutáneos surales inversos realizados entre 2007 y 2013. La edad promedio de los pacientes era de 42 años (rango 6-79); 14 hombres y 5 mujeres. Las causas de los defectos fueron: postraumáticas (17 casos, un caso bilateral) y secundarias a resecciones oncológicas (2 casos). La muestra incluyó tres pacientes diabéticos, una mujer obesa y ocho pacientes tabaquistas. En 10 casos, las heridas presentaban exposición tendinosa y, en 10 casos, exposición ósea. El diámetro promedio de los defectos fue de 8,9 x 5,75 cm.Resultados: el seguimiento promedio fue de 16 meses. Se logró una exitosa cobertura completa del defecto en los 20 casos. el tiempo promedio de internación fue de 3.15 días. Tres colgajos presentaron necrosis parcial superficial, en un caso el colgajo sufrió necrosis en su tercio distal y, en un paciente, se decidió amputar la extremidad por persistencia de la osteomielitis.Conclusiones: Pese a que se han descrito múltiples opciones de cobertura en defectos de tejidos blandos alrededor de la tibia distal, el tobillo y el pie, el colgajo sural inverso es, en la actualidad, uno de los procedimientos más frecuentes para cubrir estos defectos. Se evaluaron 20 colgajos surales inversos y se logró la cobertura completa de los defectos de tejidos blandos, tanto en defectos postraumáticos como en los resultantes de resecciones oncológicas