Distal pediküllü sural fleplerde venöz dolaşım modifikasyonları

Aydın Turan

doi:10.19161/etd.530323

EN TR

Venous circulation modifications in distal pedicled sural flaps

Abstract

Aim: The aim of this retrospective study was to evaluate the clinical results of the efficacy of a modification in the venous circulation of the distal pedicled sural flap so as to diminish the venous congestion. Materials and Methods: Fifteen patients presenting with tissue defects in the distal half of the leg were reconstructed with distal pedicled sural flaps. In 10 out of 15 patients, the sural flaps were preexpanded before transposition. The lesser saphenous vein was ligated at the proximal end of the flap before entering the pedicle and distal end of the vein was also anastomosed to a superficial leg vein to improve the venous congestion in the flap. The patients were followed up for 32 months postoperatively. Results: Partial flap necrosis was observed in the first patient of the series where a venous anastomosis was not performed, despite the vein ligation in the proximal entry to the flap. In the remaining 14 patients where a venous anastomosis was performed no flap necrosis was observed. Conclusion: Venous congestion is the main factor leading to partial or total flap necrosis in distally based sural flaps. If the lesser saphenous vein is ligated before entry to the pedicle, the venous blood of the foot could not enter the flap, but still venous congestion could ocur in flap circulation. To improve the venous congestion an additional veous anastomosis between the lesser saphenous vein and a superficial vein around the recipient area a natural venous return could be facilitated and potential complications could be avoided.

Keywords

Distally pedicled sural flap,flap viability,modifications of venous circulation.

Distal pediküllü sural fleplerde venöz dolaşım modifikasyonları

Öz

Amaç: Bu retrospektif çalışmanın amacı, distal pediküllü sural fleplerde venöz konjesyonu önlemek için venöz dolaşımda yapılan modifikasyonun klinik sonuçlarını değerlendirmektir. Gereç ve Yöntem: Araştırmada, 1/2 distal bacakta doku defekti olan toplam 15 hasta ameliyat edildi. Hastaların 10’unda ekspande edilmiş, 5’inde ise ekspande edilmemiş distal pediküllü sural flep kullanıldı. Venöz konjesyonu önlemek için lesser sapheneous vein (LSV) flebin distal ucunda alıcı alandaki yüzeyel bir vene anastomoz edildi ve flebin proksimalinde pedikül içine girmeden bağlandı. Hastalar postoperatif 32 ay takip edildi. Bulgular: Venöz anastomoz yapılmayan ilk vakada venöz konjesyon gelişti. Aralıklı flebotomi yapılmasına rağmen konjesyon giderilemedi ve flepte kısmi nekroz gelişti. Venöz anastomoz yapılan 14 vakada ise venöz konjesyon ve flep kaybı gibi herhangi bir komplikasyon gelişmedi. Sonuç: Ters akımlı sural fleplerde venöz konjesyon kısmi ya da total flep kaybı gibi komplikasyonlarının başlıca nedenidir. LSV pediküle girmeden bağlanırsa flep proksimalindeki dokuların (ayak) venöz kanı flep içine giremeyecektir. Buna ek olarak, alıcı alan çevresindeki bir yüzeyel ven ile LSV arasında anastomoz yapılırsa anterograd yani doğal bir venöz dönüş sağlanacaktır. Doğal bir venöz dönüş sağlandığı için venöz konjesyon ve buna bağlı komplikasyonlar da gelişmeyecektir.

Anahtar Kelimeler

Distal pediküllü sural flep,flep yaşamı,venöz dolaşım modifikasyonları.

References

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Details

Primary Language

Turkish

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Aydın Turan ^*
0000-0002-1540-1443
Türkiye

Publication Date

March 14, 2019

Submission Date

December 22, 2018

Acceptance Date

January 22, 2019

Published in Issue

Year 2019 Volume: 58 Number: 1

DOI

https://doi.org/10.19161/etd.530323

IZ

https://izlik.org/JA66NP76CH

Cite

RIS / Bibtex

Vancouver

1.Aydın Turan. Distal pediküllü sural fleplerde venöz dolaşım modifikasyonları. EJM. 2019 Mar. 1;58(1):68-73. doi:10.19161/etd.530323