myocutaneous flaps in the reconstruction of the inguinal structures (colgajos miocutaneos para...
TRANSCRIPT
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Transferencia Tisular en Cirugía Reconstructiva
Genital
Dr. Javier Belinky
División Urología
Hospital Carlos G. Durand
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Colgajos Miocutaneos en la Reconstrucción de las Estructuras
Inguinales
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Problema: enfermedad nodal avanzada
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Problema: enfermedad nodal avanzada
• La diseccion inguinal debe ser amplia
• El cierre primario se basa en colgajos cutaneos adelgazados y suturados a tension
• Las dehiscencias postoperatorias se asocian con morbimortalidad elevada
• Se requieren traslados de segmentos vitales (colgajo) y que aporter volumen (musculo)
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Colgajo de Recto Interno
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CRI : reparos anatomicos
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Reparo del tendon del RI
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Segmento musculocutaneo
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Segmento musculocutaneo : identificacion del pediculo
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Rotacion cefalica del CRI
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Diseccion de los colgajos cutaneos
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Diseccion de los colgajos cutaneos
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Cierre primario del lecho donante
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Segmento trasladado
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Colgajo musculocutaneo de Fascia Lata
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Defecto
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Reparos anatomicos
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Colgajo MCFL levantado
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Colgajos cutaneos disecados
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Lecho donante con escasa rotacion de los colgajos cutaneos
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Colgajos
AB
C
A) CFL B) colgajo cutaneo interno (>deslizamiento) C) colgajo cutaneo externo
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Complicaiones de CMC
• Seroma
• Hematoma
• Necrosis cutanea superficial
• Dehiscencia de herida
• Inadecuada cobertura del defecto
• Infección
• Perdida parcial del colagajo
• Perdida completa del colgajo
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Colgajos miocutaneos : Pros&co
Gracilis TFL
Segmento cutaneo Amplio Amplio
Volumen +++ +
Perdida funcional Baja (aduccion) Baja (rotacion interna)
Morbilidad lecho donante
Cierre primario comodo
Cierre primario a tension (considerar injerto)
Rotacion Porcion interna de la region inguinocrural
Porcion externa de la region inguinocrural
Tiempo quirurgico 90 – 120 minutos 90 – 120 minutos