Lambourile loco-regionale în tratamentul defectelor tegumentare actinice

Abstract

Introducere. La ora actuala tehnicile de plastie utilizate in tratamentul defectelor postexcizionale sunt in mare parte standardizate, însă în practica medicală, ne confruntam cu pacienții care au fost supuși radioterapiei. La această categorie de pacienți plastia reconstructivă impune o serie de întrebări majore, determinate de modificările pe care radiațiile ionizante le produc la nivelul țesuturilor supuse radioterapiei. Caz clinic. Lucrarea reflecta cazul clinic al unui bărbat de 61de ani supus radioterapiei după excizia formațiunii tumorale de la nivelul treimii superioare a intestinului rect. La o distanta de 2 ani după curele de radioterapie,in regiunea sacrala,tratata actinic,apare o zona de necroza de aproximativ 20x20 cm. Preoperator, zona modificata actinic a fost divizata schematic in 3 sectoare, limita dintre ele fiind intensitatea modificărilor distrofice determinate vizual. In timpul intervenției chirurgicale in exereza au fost incluse toate cele 3 sectoare, rezultând un defect in regiunea sacrala de aproximativ 20x20 cm. Conform planului de pregătire preoperatorie s-a efectuat plastia defectului cu lambou fesier bilateral,locul donator fiind închis prin sutura directa in aceeași etapa. Postoperator zonele demarcate anterior au fost separate si studiate histologic pentru determinarea exacta a zonei viabile din punctul reversibilității proceselor distrofice . Concluzie. Zona țintă pentru studiere histologica este zona II, unde examenul este informativ referitor la gradul de afectare a pielii si țesuturilor moi subadiacente. Integrarea țesuturilor transplantate din alta regiune in cazul defectelor tegumentare actinice pot avea loc după depășirea zonei II, zona III fiind descrisa histologic cu potențial de regenerare. Un examen histo-patologic preoperator al zonei actinice, permite determinarea marginii țesuturilor viabile, păstrând in unele cazuri arii de țesuturi importante.

Introduction. Plasty techniques currently used in the treatment of the defects are largely standardized. But in clinical practice, quite often we are faced with patients who were undergoing radiation therapy. In this patient’s category, reconstructive plastic surgery requires a series of questions determined by major changes produced by ionizing radiation to tissues after underwenting radiotherapy. Clinical case. This work reflects a clinical case of a man of 61 years old, that was submit to radiation therapy after tumoral excision, manifested at the level of the third upper part of the large intestine, rectum. At a distance of 2 years after radiotherapy, in the treated actinic sacral region, there was an area of necrosis of about 20x20cm. The area that was actinic changed was divided in 3 fields, the limit between them being visually. During surgery, it have been included all 3 fields, that created a defect in the sacral region, of about 20x20cm. According to the pre surgery plan, it has been done defect’s plasty with gluteal flap on the both parts, the donor place being closed by direct suture at the same stage. After surgery, the demarcated area were separated and studied histological for determination of the viable area. Conclusions. Target area for histological examination is the No.2 area, where examination is indicative in the damage of the skin and soft tissue. The integration of the tissues and organ transplant from another area in the case of actinic defect, may take place after exceeding the second field, histological appreciated with regenerative potential. A preoperative histopathology of actinic area determines the edge of the viable tissue, in some significant cases-areas with important tissue.