Üst ekstremite yumuşak doku defektlerinin serbest flepler ile rekonstrüksiyonu

Amaç: Çeşitli etiyolojik nedenler sonucu ortaya çıkabilen üst ekstremite defektlerinin rekonstrüksiyonu için literatürde pek çok yöntem tanımlanmıştır. Bu yöntemler arasında lokal veya bölgesel flepler oldukça sık kullanılmakta olup çoğu defekt başarılı bir şekilde rekonstrükte edilebilmektedir. Bununla birlikte bazı büyük ve kompleks defektlerde, teknik olarak daha zor olan serbest flep seçenekleri kaçınılmaz olabilmektedir. Çalışmamızda serbest fleplerle üst ekstremite rekonstrüksiyonu hakkındaki tecrübelerimizi sunmayı planladık. Gereç ve Yöntem: 2015 - 2021 yılları arasında 9 hastada (3 Kadın, 6 Erkek) serbest fleplerle üst ekstremite rekonstrüksiyonu uygulandı. Hastaların yaşları 22-68 arasında değişmekteydi. Serbest flep tercihlerimiz arasında 4 hastada anterolateral uyluk flebi, 4 hastada latissimus dorsi serbest flebi ve 1 hastada radial ön kol serbest flebi yer almaktaydı. Hastaların defektleri; 3 hastada el dorsumu, 1 hastada amputasyon güdüğü, 2 hastada ön kol ile birlikte el dorsumu ve 3 hastada ön kol ile birlikte dirsekte bulunmaktaydı. Bulgular: Bütün hastalarda alıcı arter olarak radial arter seçildi. Alıcı ven olarak, radial arterin konkomitan veni veya yüzeyel venöz sistem kullanıldı. 6 hastada uç-uca, 3 hastada uç-yan anastomoz yapıldı.1 hastada arteriyel tromboz ve 1 hastada venöz tromboz gözlendi. Vasküler komplikasyon görülen bu hastalarda serbest latissimus dorsi flebi tercih edilmişti. İki hasta da erken dönem kurtarma cerrahisine alınarak anastomoz hatları yenilendi ve flepler kurtarıldı. Diğer hastalarda ek komplikasyon izlenmedi. Klinik serimizde flep kaybı yaşanmadı. Sonuç: Uygun vakalarda, üst ekstremite yumuşak doku rekonstrüksiyonları için serbest flepler güvenle kullanılabilir. Teknik deneyim gerektirmekle beraber, minimal donör saha problemleri nedeniyle perforatör tabanlı serbest fleplerin oldukça avantajlı olduğu ve uygun hastalarda ilk yöntem olarak güvenle seçilebileceği kanaatindeyiz.

Reconstruction of upper extremity soft tissue defects with free flaps

Aim: Many methods have been described in the literature for the reconstruction of upper extremity defects that may occur as a result of various etiological reasons. Among these methods, local or regional flaps are used quite frequently, and most defects can be successfully reconstructed. However, in some large and complex defects, technically more difficult free flap options may be unavoidable. In our study, we present our experience on upper extremity reconstruction with free flaps. Materials and Methods: Between 2015 and 2021, 9 patients (3 Female, 6 Male) underwent upper extremity reconstructions with free flaps. The ages of the patients ranged from 22 to 68 years. Our free flap choices included anterolateral thigh flap in 4 patients, latissimus dorsi free flap in 4 patients, and radial forearm free flap in 1 patient. Defects of patients were including dorsum of the hand in 3 patients, an amputation stump in 1 patient, the dorsum of the hand with the forearm in 2 patients, and the elbow with the forearm in 3 patients. Results: The radial artery was chosen as the recipient artery in all patients. The concomitant vein of the radial artery or the superficial venous system was used as the recipient vein. End-to-end anastomosis was performed in 6 patients and end-to-side anastomosis was performed in 3 patients. Arterial thrombosis was observed in 1 patient and venous thrombosis was observed in 1 patient. All vascular complications occurred in reconstructions with latissimus dorsi free flaps. Both patients were taken to early salvage surgery, the anastomoses were renewed and the flaps were salvaged. No additional complications were observed in other patients. There was no flap loss in our clinical series. Conclusion: Free flaps can be used safely for upper extremity soft tissue reconstructions in appropriate cases. Although it requires technical experience, we believe that perforator-based free flaps are quite advantageous due to minimal donor site problems and can be safely chosen as the first method in suitable patients.

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