Der Unfallchirurg

, Volume 111, Issue 1, pp 5–11 | Cite as

Defektdeckung durch freie Lappenplastiken am Fußrücken

Funktionelle und ästhetische Aspekte
  • P. Pülzl
  • R. Pikula
  • T. Schoeller
  • D. Wolfram
  • G. Wechselberger
Originalien
First Online:

Zusammenfassung

Hintergrund

Ausgedehnte und komplexe Defekte am Fußrücken mit freiliegenden Strukturen wie Sehnen, Gelenken, Knochen, Nerven oder Gefäßen müssen mit gut durchblutetem Gewebe gedeckt werden.

Patienten und Methode

Bei 19 Patienten mit einem Durchschnittsalter von 38 Jahren wurden zur Defektdeckung 10 M.-gracilis-Lappenplastiken, 4 M.-latissimus-dorsi-Lappenplastiken, 2 Leisten-Lappenplastiken, eine anterolaterale Oberschenkel-Lappenplastik, eine anteromediale Oberschenkel-Lappenplastik und eine laterale Oberarm-Lappenplastik verwendet. Die ästhetischen Ergebnisse wurden hinsichtlich Hauttextur, Pigmentation, Dicke der Lappenplastik in Bezug zum umliegenden Hautniveau und Narbenbildung beurteilt. Zur Evaluation des funktionellen Ergebnisses wurde das Stanmore-System verwendet.

Ergebnisse

Der durchschnittliche Nachuntersuchungszeitraum betrug 29 Monate. Es kam zu keinem Lappenverlust. Eine Lappentrimmung wurde bei 6 Patienten durchgeführt. Die ästhetischen Ergebnisse waren bei der Defektdeckung mit Muskel-Lappenplastiken mit Hauttransplantaten besser als bei fasziokutanen Lappen. Laut Stanmore-Bewertungsschema erreichten 6 Patienten ein ausgezeichnetes, 5 ein gutes und 8 ein nicht zufriedenstellendes funktionelles Ergebnis.

Fazit

Muskel-Lappenplastiken mit Hauttransplantaten, insbesondere die M.-gracilis-Lappenplastik, sind den fasziokutanen und Perforans-Lappenplastiken hinsichtlich Ästhetik und Hebedefektmorbidität überlegen.

Schlüsselwörter

Fußrücken Freier Gewebetransfer Muskel-Lappenplastik Fasziokutane Lappenplastiken Ästhetik/Funktion 

Closure of defects on the dorsum of the foot with free flaps

Functional and aesthetic aspects

Abstract

Background

Large complex soft-tissue defects on the dorsum of the foot, with exposed tendons, joints, bones, nerves and vessels, have to be reconstructed by transplantation of free tissue grafts with good blood flow.

Patients and methods

Evaluation of 19 patients with an average age of 38 years who underwent closure of defects on the dorsum of the foot with free muscle flaps (with split-thickness skin grafts) in 14 cases and with free fasciocutaneous flaps in 5 is presented. In 10 patients a gracilis muscle flap was used, in 4 patients a latissimus dorsi flap, and in 2 patients a groin flap, while in 1 patient each an anterolateral thigh flap, an anteromedial thigh flap and a lateral arm flap was used. The aesthetic outcome was evaluated with reference to skin texture, pigmentation, thickness of the free flap and scar formation. The Stanmore system was used to determine the postoperative functional results.

Results

On average, patients were followed up for 29 months. We had no flap loss. A flap debulking procedure was performed in 6 patients. Better aesthetic results were obtained with muscle flaps plus skin graft than with fasciocutaneous flaps. Functional results were excellent in 6 patients, good in 5 and poor in 8 patients.

Conclusion

Free muscle flaps with skin grafts, particularly the free gracilis muscle flap, are superior to fasciocutaneous flaps and perforating flaps in aesthetic outcome and donor site morbidity.

Keywords

Dorsum of the foot Free tissue transplantation Free muscle flaps Fasciocutaneous flaps Aesthetics/function 
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Notes

Interessenkonflikt

Der korrepondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • P. Pülzl
    • 1
  • R. Pikula
    • 1
  • T. Schoeller
    • 1
  • D. Wolfram
    • 1
  • G. Wechselberger
    • 1
  1. 1.Universitätsklinik für Plastische- und WiederherstellungschirurgieMedizinische Universität InnsbruckInnsbruckÖsterreich

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