Interdisziplinäre, primäre Rekonstruktion des Perineums zur Vermeidung von Wundkomplikationen nach abdominoperinealer Rektumexstirpation

Mohr, Z.; Palmer, Björn; Zender, F. J.; Willis, S.; Lehnhardt, M.; Daigeler, Adrien; Kremer, Thomas; Hirche, Christoph

doi:10.1055/s-0032-1315236

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…In addition, such chronic and sometimes secretive wounds can become a heavy burden for the patient and her/his relatives. The closure of resulting defects using a myocutaneous flap plasty has proved successful [ 27 ]. According to the extent of the defect, various flap plasties are considered [ 23 , 24 , 28 – 35 ].…”

Section: Corner Pointsmentioning

confidence: 99%

Interdisciplinary aspects of abdominal and plastic surgery – what does the (abdominal) surgeon need to know?

Kraus,

Damert,

Meyer

2023

Innovative Surgical Sciences

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Introduction The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons. Content – Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or “tensor-fascia-lata” (TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber). – Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps. – Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight. – Abdominoperineal rectum extirpation (APE): Holm’s procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty. – Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension. – Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty. – Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time – plastic surgery expertise has to be included into interdisciplinary tumor concepts. – Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose. – Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer). – Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e., surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve. – Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed by plastic surgery coverage can prevent chronification, threatening mediastinitis, persisting infectious risk, long-term suffering or limited quality of life. Summary The presented selection of single topics can only be an excerpt of all the options for surgical cooperation in daily clinical and surgical practice. Outlook An interdisciplinary approach of abdominal and plastic surgery is characterized by a highly developed cooperation in common surgical interventions including various techniques and tactics highlighting the specifics of the two fields.

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Section: Corner Pointsmentioning

confidence: 99%

Interdisciplinary aspects of abdominal and plastic surgery – what does the (abdominal) surgeon need to know?

Kraus,

Damert,

Meyer

2023

Innovative Surgical Sciences

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“…Insbesondere die Analyse der vorhandenen Situation und die Planung weiterer Operationen braucht einiges an Erfahrung [13][14][15]. In der Vielzahl der Fälle findet sich autologes Material der angrenzenden Körperareale, welches für eine dauerhafte und stabile Rekonstruktion verwendet werden kann [1,[16][17][18][19][20][21][22][23][24][25]. Sollte dies nicht der Fall sein, kommen ggf.…”

Section: Diskussion !unclassified

Was der Allgemein-, Viszeral- & Gefäßchirurg über plastische Chirurgie wissen sollte – plastisch-chirurgische Aspekte in der Allgemein- & Viszeralchirurgie

et al. 2014

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There is overlap between general, abdominal and vascular surgery on one hand and plastic surgery on the other hand, e.g., in hernia surgery, in particular, recurrent hernia, reconstruction of the abdominal wall or defect closure after abdominal or vascular surgery. Bariatric operations involve both special fields too. Plastic surgeons sometimes use skin and muscle compartments of the abdominal wall for reconstruction at other regions of the body. This article aims to i) give an overview about functional, anatomic and clinical aspects as well as the potential of surgical interventions in plastic surgery. General/abdominal/vascular surgeons can benefit from this in their surgical planning and competent execution of their own surgical interventions with limited morbidity/lethality and an optimal, in particular, functional as well as aesthetic outcome, ii) support the interdisciplinary work of general/abdominal/vascular and plastic surgery, and iii) provide a better understanding of plastic surgery and its profile of surgical interventions and options.

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Interdisziplinäre, primäre Rekonstruktion des Perineums zur Vermeidung von Wundkomplikationen nach abdominoperinealer Rektumexstirpation

Cited by 2 publications

References 16 publications

Interdisciplinary aspects of abdominal and plastic surgery – what does the (abdominal) surgeon need to know?

Interdisciplinary aspects of abdominal and plastic surgery – what does the (abdominal) surgeon need to know?

Was der Allgemein-, Viszeral- & Gefäßchirurg über plastische Chirurgie wissen sollte – plastisch-chirurgische Aspekte in der Allgemein- & Viszeralchirurgie

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