Progressive chronic diseases and acute traumatic injuries can compromise cutaneous and soft tissues of the limbs leading to limitation or loss of their function. The role of the plastic surgeon is to reconstruct, repair and restore the morphologic-functional defects of the affected limb. The choice of the reconstructive technique depends on several factors such as age of the patient, duration and nature of the disease, characteristics of the wound, and conditions of the surrounding tissues. The most commonly used surgical reconstructive options include skin grafts, acellular dermal matrices, and loco-regional or free microsurgical flaps. Reconstruction of complex and rare limb diseases often represents a challenge for the plastic surgeon. Well-described reconstructive techniques must be customized for each patient. Rare diseases are uncommon and there are no guidelines to provide rules for selecting the best reconstructive option. It is mandatory to know the armamentarium of the described techniques in order to develop innovative and useful reconstructive methods. The aim of this research is to: (i) review the described reconstructive techniques about rare limb diseases; (ii) provide a management strategy of complex patients; (iii) study and develop alternative reconstructive approaches. Rare limb disorders have infectious, autoimmune or traumatic etiology. Specifically, the-state-of-the-art and innovative reconstructive methods related to lymphedematous, sclerotic and traumatic limb pathologies are presented. For what concerns limb lymphedema, efficacy of the medical and microsurgical combination is highlighted. With regard to systemic sclerosis digital ulcers, technical innovations in the application of modern technological devices and in the use of autologous adipose are illustrated. Finally, representative cases of extensive limb necrosis are reported in order to improve care pathways. The results of this research provide effective and alternative strategies of diagnostic and therapeutic management encouraging the approach to rare and challenging limb diseases and leading to implementation of reconstructive techniques.
Le patologie croniche progressive o gli eventi acuti di natura traumatica possono compromettere lo stato della cute e dei tessuti molli degli arti determinandone la limitazione o la perdita della funzionalità. Compito del chirurgo plastico è tentare di correggere, riparare o ricostituire i difetti morfologico-funzionali o le perdite di sostanza dell’arto affetto. La scelta della tecnica ricostruttiva più appropriata è dettata dall’età del paziente, dalla durata e dalla natura dell’affezione, dalle caratteristiche delle lesioni e dalle condizioni dei tessuti circostanti. Le opzioni chirurgiche più comunemente utilizzate includono l’utilizzo di innesti cutanei o adiposo, l’utilizzo di matrici dermiche e l’allestimento di lembi loco-regionali o liberi microchirurgici. La risoluzione di patologie dell’arto di raro riscontro spesso rappresenta una sfida per il chirurgo plastico in quanto le diverse tecniche ricostruttive devono essere personalizzate al singolo paziente. La rarità della patologia comporta la mancanza e la frammentarietà di evidenze scientifiche che possano guidare il chirurgo nell’iter terapeutico più appropriato. È necessario possedere un’ampia conoscenza dell’armamentario delle tecniche ricostruttive descritte in letteratura al fine di poter contribuire alla sistematizzazione e all’ampliamento delle stesse. La presente ricerca si pone l’obiettivo di analizzare le diverse tecniche descritte per rare patologie dell’arto di interesse plastico-ricostruttivo, di fornire indicazioni operative per la gestione di casi complessi e di illustrare metodi ricostruttivi alternativi attraverso l’effettuazione di studi clinici innovativi. Patologie di raro riscontro possono essere di natura infettiva, autoimmunitaria o traumatica. In particolare, si illustrano lo stato dell’arte e i metodi ricostruttivi innovativi relativi alle patologie linfedematosa, sclerodermica e traumatica. Per quanto attiene il linfedema, vengono mostrati i risultati ottenuti attraverso l’applicazione della combinazione di terapia medica e soluzioni microchirurgiche. Le ulcere digitali della sclerosi sistemica, spesso risultanti in fenomeni amputativi, possono beneficiare dell’applicazione di dispositivi tecnologici ma anche dell’utilizzo di tessuto adiposo autologo di cui vengono presentate le innovazioni tecniche. Infine casi di estesa necrosi dell’arto richiedono competenze tecniche gestionali di cui vengono illustrati casi significativi ed emblematici. I risultati della ricerca effettuata quindi ampliano le possibilità ricostruttive delle patologie rare e complesse dell’arto fornendo gli elementi necessari al corretto inquadramento diagnostico-terapeutico del paziente e presentando valide alternative alle tecniche ricostruttive descritte.
Rare e complesse patologie dei tessuti molli degli arti: strategie di gestione, opzioni ricostruttive innovative e soluzioni microchirurgiche
Starnoni, Marta
2024
Abstract
Progressive chronic diseases and acute traumatic injuries can compromise cutaneous and soft tissues of the limbs leading to limitation or loss of their function. The role of the plastic surgeon is to reconstruct, repair and restore the morphologic-functional defects of the affected limb. The choice of the reconstructive technique depends on several factors such as age of the patient, duration and nature of the disease, characteristics of the wound, and conditions of the surrounding tissues. The most commonly used surgical reconstructive options include skin grafts, acellular dermal matrices, and loco-regional or free microsurgical flaps. Reconstruction of complex and rare limb diseases often represents a challenge for the plastic surgeon. Well-described reconstructive techniques must be customized for each patient. Rare diseases are uncommon and there are no guidelines to provide rules for selecting the best reconstructive option. It is mandatory to know the armamentarium of the described techniques in order to develop innovative and useful reconstructive methods. The aim of this research is to: (i) review the described reconstructive techniques about rare limb diseases; (ii) provide a management strategy of complex patients; (iii) study and develop alternative reconstructive approaches. Rare limb disorders have infectious, autoimmune or traumatic etiology. Specifically, the-state-of-the-art and innovative reconstructive methods related to lymphedematous, sclerotic and traumatic limb pathologies are presented. For what concerns limb lymphedema, efficacy of the medical and microsurgical combination is highlighted. With regard to systemic sclerosis digital ulcers, technical innovations in the application of modern technological devices and in the use of autologous adipose are illustrated. Finally, representative cases of extensive limb necrosis are reported in order to improve care pathways. The results of this research provide effective and alternative strategies of diagnostic and therapeutic management encouraging the approach to rare and challenging limb diseases and leading to implementation of reconstructive techniques.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.14242/157045
URN:NBN:IT:UNIMORE-157045