Colgajos de las perforantes del pie: problemas y posibles soluciones Foot perforator flaps: problems and possible solutions

A pesar de diversas publicaciones existentes sobre el colgajo mediano plantar tradicional, los colgajos de las perforantes del pie no están suficientemente estudiados. Es necesario ampliar nuestros conocimientos sobre la anatomía vascular de esta región, los problemas que pueden surgir durante la disección de la zona y las posibles soluciones. Realizamos disección anatómica de 10 pies de cadáver utilizando relleno vascular con látex coloreado. Definimos la secuencia de la disección de las perforantes de la arteria plantar medial. Medimos los puntos de salida de las perforantes dominantes en relación con 3 puntos de referencia, diámetro y longitud de cada perforante. Evaluamos la utilidad de cada colgajo para su uso en reconstrucción local o a distancia en función del diámetro y la longitud de la perforante, grosor del colgajo y morbilidad de la zona donante. Los colgajos de los vasos perforantes del pie son una buena opción para la reconstrucción tanto local como a distancia, con una mínima morbilidad de la zona donante y con un buen resultado funcional gracias a las características del tejido del pie cuando se usa para reconstrucción en mano.<br>Traditional medial plantar flap is widely described in the literature, but foot perforator flap is a relatively new subject which still needs more detailed anatomical investigation. We need to amplify our knowledge about this surgically challenging region, dissection difficulties and possible solutions. We performed anatomical dissection on 10 cadaver feet with dyed latex intravascular injection and then dissected out the perforators arising from the medial plantar artery. We measured the origin of the dominant perforators in relationship to 3 reference points, diameter and length of each perforator. We analyzed the application of flaps based on these perforators as local and free flaps in relation to pedicle length and diameter, flap thickness and donor site morbidity. Foot perforator flaps are a good option for local and distant reconstruction. Donor site morbidity is low and functional result is good due to tissue characteristics of the foot region when used for hand reconstruction

Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction

Background: Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR. Methods: The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy. Results: A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21·0 per cent; mastectomy: 570, 37·2 per cent; mastectomy and IBR: 359, 35·6 per cent; P &lt; 0·001). Breast conservation was possible in 87·0 per cent of patients who had TM, and TM did not delay adjuvant treatment. Conclusion: TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety