LIPOENXERTIA NO TRATAMENTO DE FERIDAS COMPLEXAS NO SUS: UMA SÉRIE DE CASOS

Introduction: There is no gold standard therapy for the treatment of complex wounds, which promotes better aesthetic-functional results, in addition to reducing current morbidity and mortality rates and healthcare costs in Brazil. Fat grafting represents a promising therapeutic option due to its regenerative properties. Methods: This is a retrospective case series study, with analysis of electronic medical records of 4 patients who underwent fat grafting on complex wounds in a Reconstructive Plastic Surgery service, from October 2019 to October 2023. Results: All 4 patients had some serious decompensated comorbidity. Patient 1, with a 10 cm ulcer with bone and tendon exposure on the left ankle. Two fat grafts were performed with a vacuum dressing, followed by a dermal-epidermal graft on the lesion. Patient 2, with venous ulcers on the right leg. After fat grafting on the wounds, the patient did not want to remain hospitalized. The dressing was opened in an outpatient setting, and the bed was found to be rich in granulation tissue. Outpatient follow-up and simple dressings were carried out at the UBS. Patient 3, with infected varicose ulcers on the lower limbs with tendon exposure. Despite fat grafting, the wound developed extensive fibrin and a foul odor. We then opted for outpatient follow-up with local dressings. Patient 4, with a wound on the plantar surface of the right foot with tendon exposure. Seven days after debridement and angioplasty, fat grafting was performed on the lesion. However, the patient developed an indication for amputation through Vascular Surgery. Discussion: The application of fat grafting ensured the formation of granulation tissue in the wound bed and the success of other wound coverage techniques. The varied results prove that the success of the treatment depends on numerous factors directly related to the patients. Conclusion: Easy application, availability and low cost make fat grafting viable in the SUS Plastic Surgery Service.