Avaliação do uso de azul de metileno como mapeamento trans-operatório da vascularização do retalho transverso do músculo reto do abdome monopediculado em humanos

• Ano de defesa: 2005
• Autor(a) principal: Doncatto, Léo Francisco
• Orientador(a): Silva, Jefferson Luis Braga da
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Pontifícia Universidade Católica do Rio Grande do Sul; Porto Alegre
• Palavras-chave em Português: MEDICINA; CIRURGIA PLÁSTICA; MAMA; MASTOLOGIA
• Link de acesso: http://hdl.handle.net/10923/4621

INTRODUCTION: The transverse rectus abdominis musculocutaneous flap (TRAM flap) has been largely used for breast reconstruction. The morbidity caused by its use presents high incidence of complications. PATIENTS AND METHODS – An experimental study of internal control (before-and-after) with 21 patients that underwent mammary reconstruction is presented here. The areas with less vascularization were named ischemic. The estimated ischemic rate among the 4 studied vascular zones of the superficial cutaneous flaps have been compared. One described the occurrence of necrosis and one evaluated the adequation of the vascular mapping by the methylene blue dye as a predictor of necrosis. RESULTS – Necrosis as a clinical finding occurred in 6 of the 21 patients studied, all located in zone 2, with an estimated rate of necrosis of 28. 6%. The methylene blue dye technique significantly predicted flap necrosis by the binomial test (p=0,799). Moreover, the ischemic rate identified 3 distinct groups: the first with higher rate in zone 4, the second with intermediate rates in zone 2 and the last group, in zones 1 and 3, presented with low rates of ischemia (p<0. 05). The method showed to be simple, feasible, and without complications. CONCLUSION – The use of methylene blue dye in the cutaneous flap mapping has lead to a reduction in the number of cases that resulted in necrosis, although no statistical significance was demonstrated here (p=0,52). Furthermore, the technique is efficient as a predictor tool of ischemia and necrosis occurrence in the flap surface. Zones 1 and 3 presented smaller areas of ischemia in oppose to zone 4 with larger area. Zone 2 was the only one detected with necrosis by clinical exam.