Retalho de padrão axial tubular para correção de defeito em cotovelo após excisão de neoplasia : relato de dois casos

Abstract

In veterinary medicine, reconstructive surgery is performed in order to correct major injuries resulting from trauma, congenital anomalies and excision of nodules. The objective of this report was to evaluate 2 cases in which it was necessary to perform reconstructive techniques for exceresis of the nodule in the elbow using the reconstructive technique adapted to enable the cultural repair after the surgical wound. Cases: Two dogs with neoplasms in the elbow were treated at the Veterinary Hospital of UFMT, campus Cuiabá. Case I: dog I, male, 8 years old, with a tumor measuring 10.1 x 4.3 x 9.3 cm, adhered, firm consistency, ulcerated and evolution of six months. Case II: dog II with the neoplasm measuring 8.0 x 6.0 x 5.0 cm, adhered circularly, ulcerated, with areas of necrosis, evolution time of 3 months. For both cases, due to the extent of the lesions and the location of development of the tumors, reconstructive surgery was performed. The flap of thoracodorsal axial pattern with tube, was the technique of choice for the repair of the originated defects. In both cases, the surgeries were performed in 2 stages, the first surgery to exercise and reconstruct the wound and a second time to remove the tube. However, for case I, it was necessary to carry out an adaptation of the technique during the removal of the tube, as it would have to be removed before coaptation with the surgical wound. For this it was necessary to create a rectangular defect at the height of the scapula with removal of the skin of the limb. Then the tube was opened ventrally so that it could be sutured in the surgical wound of the scapula, without the need to cut the irrigating bed of the wound. In case II, the technique of removing the tube consisted of cutting the edges of the tubes in the portion close to the scapula and the portion close to the elbow. Dog I was diagnosed in histopathology with fibrosarcoma and dog II with sarcoma, and dog II had a better prognosis. Complications such as edema, fluid drainage, seroma and partial necrosis were observed in dog II, however, most of the flap showed adequate healing in the recipient bed and the cosmetic aspect was considered satisfactory. Both had adequate healing, the difference between them was the time between discharge and the tutor's availability to assist in the post-operative period with tube care. Discussion: Low fibrosarcoma occurs in dogs, about 1.5%, and its occurrence is greater in the oral cavity and face. Fibroma is a benign neoplasm that is also uncommon in dogs. The primary treatment indicated for both cases consists of excision of the tumor mass with a wide safety margin, in this region the skin elasticity and the tension in the involved areas were evaluated and require reconstructive surgery, being evaluated all types of grafts available. The majority of thoracodorsal axial flaps clinically reported in dogs are used to repair wounds in the olecranon or proximal forearm, as in these cases. We opted for this type of flap, since 95% survival was experimentally verified. Tubular grafts are generally used in the distal portion of the limbs and elbow region, as in this report, their adaptation of the thoracodorsal axial flap with the tubular graft was the option selected for this case due to the more distal position of the neoplasm and the size of the lesion . With this study it was possible to ascertain that the post-operative with the tube until the complete flap copatation is necessary the tutor's disposition with care. Case I in which it was necessary to adapt the technique to discharge was faster than case II, but both were successful.