Karmaþýk üst uzuv defektlerinde ‘posterior interosseöz flebin’ çok yönlü kullanýmý

AMAÇ: Üst ekstremitenin kompleks anatomik ve fonksiyonel yapýsý, bu bölgeye ait kompleks defektlerin onarýmýnýn rekonstrüktif cerrahlar için zor bir iþlem olmasýna neden olmaktadýr. Bu rekonstrüksiyonda kompozit dokularý içeren lokal ve bölgesel flep seçenekleri kýsýtlýdýr. Bu çalýþmadaki amaç; posteriyor interosseöz flebinin (PÝO) klinik pratikte çok yönlü kullanýlabilirliðini vurgulamak ve kompleks üst ekstremite defektlerinde iyi bir seçenek olduðunu belirtmektir.
GEREÇ VE YÖNTEM: Çalýþmada üst ekstremite defekti mevcut 18'i erkek, 7'si kadýn toplam 25 hastaya, 26 PÝO flebi uygulandý. Baþlýca etyolojik faktörler, yanýk kontraktürü, trafik kazasý, ateþli silah yaralanmasý ve akut yanýk yaralanmasý idi. 22 flep fasyokutanöz kaldýrýlrken, 4 flep osteofasyokutanöz þekilde kaldýrýlarak metakarp defektlerine uygulandý. Pediküllü transfer edilen 25 flebin, 23'ü ters, 2'si ise düz akýmlý idi. Bir flep ise serbest flep olarak transfer edildi.
BULGULAR: Ortalama takip süresi 14 ay idi. Parsiyel nekroz ve sekonder iyileþme ile düzelen 1 flep hariç geri kalan fleplerin tamamý bütünüyle sorunsuz iyileþti. Tüm hastalar geç postoperatif dönemde günlük iþlerini sürdürebilecek temel fonksiyonlarý kazandýlar. Hastalar ve/veya anne babalarý postoperatif fonksiyonel ve estetik geliþimden memnun kaldýlar.
TARTIÞMA: PIO flebinin birçok avantajý, üst ekstremite kompleks defektlerinde kullanýlabilir olmasýný saðlamaktadýr. Akým yönünün deðiþtirilebilirliði ve içeriðinin zenginleþtirilebilmesi sayesinde çok yönlü olarak kullanýlabilir.

Versatile use of the posterior interosseous flap in the reconstruction of complex upper limb defects

BACKGROUND: Reconstruction of the complex upper extremity defects is a challenging procedure for reconstructive surgeons because of the complex anatomical and functional structure of this region. In reconstruction, local and regional flap options involving the composite tissues are restricted. The posterior interosseous flap (PIO) has been presented “in a single study” with a wide variety of uses, and in this study, the versatility of PIO has been tried to be emphasized by its multitude uses as well as its chance at adaptability to each case. Hence, due to this, the objective to highlight the versatile utility of the PIO flap in clinical practice and to present a good option for the reconstruction of complex upper limb defects for various cases have been targeted.
METHODS: We used 26 PIO flaps in 25 patients (18 male and seven female patients) with upper limb defects. The main etiological causes were burn contracture, traffic accident, firearm and acute burn injury. Twenty-two flaps were harvested as fasciocutaneous and four flaps as osteo-fasciocutaneous manner, which were applied to the metacarpal defects. In this study, 25 flaps were transferred as pedicled flaps, of which 23 and 2 flaps had reverse and antegrade blood flows, respectively, whereas one flap was used as a free flap.
RESULTS: The mean follow-up period was 14 months. All flaps except one, which had partial necrosis and secondary healed, survived completely. All patients were able to gain basic functions for daily routine activities in the late postoperative period. Patients and/or their parents were satisfied with the postoperative functional and aesthetic improvements.
CONCLUSION: Many advantages of the PIO flap make it useful for the reconstruction of upper limb complex defects. It can be versatilely used based on changing its flow direction and enrichment of contents.