Treatment of actinic skin defect using locoregional island flap

Abstract

Introduction: plasty techniques currently used in the treatment of the defects are largely standarldized, but in clinical practice, quite often we are faced with patients who were undergoing radiation therapy for the treatment of certain lesion (malignant or benign ). In this category require reconstructive plastic surgery, patients, with major changes that produce ionizing radiation to tissues undergo radiotherapy. Clinical case: This work reflect a clinical case of a man 61 years, that was submit to radiation therapy after tumoral excision, manifests itself at the level of the third upper part of the large intestine, rectum. At a distance of 2 years after radiotherapy, equivalent in the amount of 60 Gy in the sacral region treated actinic, there was an area of necrosis, about 20x20cm.The area that was actinic changed, was divided in 3 filed, the limit between them being visualy determined by the intensity of the dystrophic changes, so the field 1 included the central area with the highest degree of necrosis, and the field 3 with marginal erythema. During surgery, have been included all the 3 field, that created a defect in sacral region, about 20x20cm. According to the presurgery plan, it has been done plasty defect 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 the viable area. Conclusion: target area for histological examination is the area nr.II 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 field II, 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.