Prinzipien und M�glichkeiten der Rekonstruktion mit mikrochirurgischen Lappenplastiken

Self Cite

In defect reconstruction following radical oncologic resection of malignant chest wall tumors, adequate soft-tissue reconstruction must be achieved along with function, stability, integrity, and aesthetics of the chest wall. The purpose of this retrospective analysis was to evaluate the oncoplastic concept following radical resection of malignant chest wall infiltration with an interdisciplinary approach. Between 1999 and 2005, 36 consecutive patients (nine males, 27 females, mean age 55 years, range 20-78) were treated with resection for malignant tumors of the chest wall. Indications were locally recurrent breast carcinoma (patient n=22), thymoma (n=1), and desmoid tumor (n=1). Primary lesions of the chest wall were spinalioma (n=1), sarcoma (n=7), and non-small-cell lung cancer (n=2). There were distant metastases of colon and cervical cancer in one patient each. Soft-tissue reconstruction was carried out using primary closure (n=1), external oblique flap (n=1), pectoralis major myocutaneous flap (n=3), latissimus dorsi myocutaneous flap (n=18), vertical or transversal rectus abdominis myocutaneous flap (n=9), free tensor fascia lata- flap (n=6), trapezius flap (n=1), serratus flap (n=1), and one filet flap. In 15 reconstructive procedures microvascular techniques were used. An average of 3.4 ribs were resected. Stability of the chest wall was obtained with synthetic meshes. The latissimus dorsi flap is considered the flap of choice in chest wall reconstruction. However, alternatives such as pectoralis major flap, VRAM/TRAM flap, free TFL flap, and serratus flap must also be considered. Low mortality and morbidity rates allow tumor resection and chest wall reconstruction even in a palliative setting.

Section: Musculus-latissimus-dorsi-lappenunclassified

“…In solchen Fällen müssen diese Lappen in Kombination miteinander oder unter Verwendung mikrovaskulärer Techniken angewendet werden [2,15,17,25]. Cordeiro [10,11,12,18,44].…”

Section: Lappenkombinationen Und Mikrovaskuläre Technikenunclassified

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Plastisch-chirurgische Rekonstruktion von Defekten der Thoraxwand nach onkologischen Resektionen

Riedel

Kremer

Hoffmann

et al. 2007

Self Cite

“…6-10 cm bei einem Durchmesser von ca. 2-4 mm [1,8,10,12]. Bis zu einer Länge von 25 cm und einer Breite von ca.…”

Section: Op-technikunclassified

Free scapular or parascapular flaps for soft tissue damage accompanying talus or calcaneus fractures

Dumont

Burchhardt

Dresing

et al. 2007

“…Der Perforatorlappen ist definiert durch den Ursprung seiner Gefäßversor-gung aus einem tiefer liegenden axialen Gefäß, welches dann durch die unterliegende Muskulatur oder ein intermuskuläres Septum an die Oberfläche tritt, sich subkutan verzweigt und durch Einspeisung in den subdermalen Plexus das Subkutangewebe und die Haut versorgt [4,18,47]. Die am häufigsten eingesetzten Perforatorlappen sind derzeit der Deep-inferior-epigastric-perforator-(DIEP-)Lappen zur Mammarekonstruktion und der "anterior lateral thigh flap" (ALT) zur Rekonstruktion flächiger Defekte an den Extremitäten [1, 14,15,25].…”

Section: Bauchwandhernien Als Folge Von Hebedefekten Nach Abdominalenunclassified

Bauchwandhernien als Folge von Hebedefekten nach abdominalen Lappenplastiken

Germann

Sauerbier

Unglaub

2006

Self Cite

The anatomic characteristics of the anterior abdominal wall allow the harvesting of various types of flaps, some of them with considerable volume. These flaps are used mainly for reconstruction of the female breast, thoracic wall, and perineal or ilioinguinal region. Even though general donor site morbidity is low, hernias and "bulging" can occur due to the harvest of muscle and fascia, which leads to a weakening of the abdominal wall. Hernias and bulging appear mostly after harvest of classic flap types, which include removal of the rectus abdominis muscle. Further refinements of these flaps, i.e. microvascular flaps, in particular perforator flaps, lead to a marked reduction in donor site morbidity. In the following overview, the problem of abdominal wall weakening as a result of flap harvest is discussed and possible therapeutic options are elucidated.