Loco-regional flap in treatment of actinic skin defect

Abstract

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 patients 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 20x20 cm. 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 20x20 cm. 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: 1. Target area for histological examination is the No.2 area, where examination is indicative in the damage of the skin and soft tissue. 2. 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. 3. A preoperative histopathology of actinic area determines the edge of the viable tissue, in some significant cases-areas with important tissue