Fibrin glue application in free flaps was feasible and allowed us to complete the anastomoses with fewer sutures and less time. The survival rate of the flaps was not adversely affected by the fibrin glue.

The purpose of this study was to observe whether the results of the median nerve fascicle transfer to the biceps are equivalent to the classical ulnar nerve fascicle transfer, in terms of elbow flexion strength and donor nerve morbidity. Twenty-five consecutive patients were operated between March 2007 and July 2013. The patients were divided into two groups. In Group 1 (n = 8), the patients received an ulnar nerve fascicle transfer to the biceps motor branch. In Group 2 (n = 15), the patients received a median nerve fascicle transfer to the biceps motor branch. Two patients with follow-up less than six months were excluded. Both groups were similar regarding age (P = 0.070), interval of injury (P = 0.185), and follow-up period (P = 0.477). Elbow flexion against gravity was achieved in 7 of 8 (87.5%) patients in Group 1, versus 14 of 15 (93.3%) patients in Group 2 (P = 1.000). The level of injury (C5-C6 or C5-C7) did not affect anti-gravity elbow flexion recovery in both the groups (P = 1.000). It was concluded that the median nerve fascicle transfer to the biceps is as good as the ulnar nerve fascicle transfer, even in C5-C7 injuries.

The independent risk factors for complications were ischemia time of free flap > two hours  and obesity.

On the basis of these results, it is concluded that perforating flaps are a good choice of treatment for skin losses, especially in the distal segment of the leg, and could be an alternative option for the use of free microsurgical flaps.

Os retalhos de vasos perfurantes representam um avanço no tratamento das perdas cutâneas. No terço distal da perna as opções para a cobertura cutânea são poucas e muitas vezes devemos recorrer a microcirurgia. Neste trabalho realizou-se uma avaliação prospectiva de 20 pacientes submetidos ao tratamento de áreas cruentas no terço distal da perna através de retalhos pediculados em artéria perfurante. A localização das artéria perfurantes foi feita , no pré-operatório , através do exame de eco-doppler. Os retalhos foram planejados de forma a permitir sua rotação junto à área cruenta em até 180 graus. Em 6 casos os vasos perfurantes tinham como origem a artéria fibular, em 10 a artéria tibial posterior e 4 a artéria tibial anterior. O índice de acerto do eco-doppler foi de 88,2%. Em pacientes jovens com lesões traumáticas houve 15,4% de falha do procedimento e 33,3% em pacientes com morbidades associadas. Baseado em nossos resultados concluímos ser o retalho de perfurante uma boa opção de tratamento das perdas cutâneas no segmento distal da perna.