Rekonstruktion komplexer Rumpfdefekte mittels gestielter und freier Lappenplastiken in Kombination mit arteriovenösen Loops

 

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Zusammenfassung

Große Rumpfdefekte treten nach umfangreichen onkologischen Resektionen, Traumata, Infektionen oder adjuvanten Bestrahlungen auf und erfordern häufig komplexe Rekonstruktionen. Bei mehrschichtigen Haut-Weichteil-Defekten ohne Möglichkeit des Primärverschlusses sind bei Ausreizen von lokalen Lappenplastiken Defektdeckungen mittels freier Lappenplastiken notwendig. Arteriovenöse Loops können hierbei eine Überbrückung zu Anschlussgefäßen möglich machen bei limitierten lokalen Anschlussmöglichkeiten und in Kombination mit freien Lappenplastiken eingesetzt werden. Das Armamentarium zur Defektdeckung beinhaltet eine Vielzahl freier Lappenplastiken, die in Abhängigkeit von der Defektkonfiguration ausgewählt werden. Zur Rekonstruktion stehen gängige Lappenplastiken zur Verfügung wie der perforatorbasierte Anterolateral-Thigh-Lappen (ALT-Lappen), aber auch Muskellappenplastiken mit und ohne Hautinsel wie die M.-latissimus-dorsi-Lappenplastik oder die M.-vastus-lateralis-Lappenplastik. Eine frühzeitige interdisziplinäre Zusammenarbeit verschiedener Fachdisziplinen unter Einbindung von plastisch-rekonstruktiven Chirurgen kann den Defektverschluss von kritisch großen Defekten ermöglichen.

Abstract

Large trunk defects occur after extensive oncological resections, trauma, infections or adjuvant radiotherapy and often require complex reconstructions. In the case of multi-layered skin soft tissue defects without the possibility of primary closure, defect coverage using free flaps is necessary if local flap options are exhausted. AV loops can bridge to recipient vessels if local options are limited and are used in combination with free flaps. A plethora of free flaps is available in the armamentarium for defect coverage, which are selected according to the reconstruction required. Common flaps for reconstruction are the perforator-based anterolateral thigh flap (ALT flap), but also muscle-bearing flaps with and without a skin island, such as the latissimus dorsi flap or the vastus lateralis flap. Early interdisciplinary collaboration between different specialist disciplines – with the involvement of plastic-reconstructive surgeons – can enable the closure of critically large defects.

Publication History

Received: 23 March 2025

Accepted after revision: 28 April 2025

Article published online:
20 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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