Visão geral dos retalhos para reconstrução de tecidos moles

Abstract

Introduction: Flaps are very versatile and can be used to fill large defects, recreate structures such as the breast, or provide better coverage over joints. Flaps, such as the gracilis flap, are available to be transferred as complete muscle units, allowing return of function when connected to the recipient nerves. The volume of tissue transferred can contain several types of tissue, including skin, muscle, nerve, fascia, and bone. The larger volume of tissue transferred requires constant perfusion and will be compromised if arterial supply or venous drainage is interrupted during or after tissue transfer. Donor site morbidity is often minimal but can be significant depending on the flap chosen. Objective: To discuss an overview of flaps for soft tissue reconstruction. Methodology: Literature review from Scielo, PubMed, and BVS databases, from April to June 2024, with descriptors “Overview”, “Flaps”, and “Soft Tissues”. Articles from 2019-2024 (total 43) were included, excluding other criteria and selecting 05 full-text articles. Results and Discussion: A surgical flap is a transfer of tissue with its blood supply from one part of the body to another. The blood supply to a flap is persistent and independent of the recipient bed. A flap is the best approach for wound repair when primary repair is not achieved, the wound bed is not amenable to grafting, or the aesthetics are unfavorable for grafting. In general, flaps for reconstruction are classified based on the type of blood supply (i.e., random, axial), proximity of the donor tissue to the recipient (i.e., local, regional, distant), and tissue composition (e.g., musculocutaneous, fasciocutaneous). Flaps can also be classified based on how the donor tissue is transferred to the recipient tissue defect (e.g., rotation, advancement). Flap selection begins with an analysis of the defect location, vascularity of the defect bed, comorbidities, cosmetic significance, and functional significance. As a general rule, simpler local and regional flaps are used if possible. More complicated flaps, such as pedicled or distant free flaps, are used if simpler options are not available or if a distant flap provides a better overall functional and cosmetic result. Conclusion: Vascular compromise is the most common cause of flap failure. Vascular compromise may occur due to torsion of the vascular pedicle during flap transfer to the recipient site. For free flaps, vascular compromise is usually due to thrombosis of the artery or vein included in the microanastomosis. When available, both Doppler ultrasound and continuous tissue oximetry should be used to monitor free flaps during the first three days after surgery.