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Bauchwandhernien als Folge von Hebedefekten nach abdominalen Lappenplastiken

Abdominal hernias resulting from abdominal flap harvest

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Zusammenfassung

Die vordere Bauchwand bietet durch ihre Anatomie die Möglichkeit verschiedenste Lappentypen mit zum Teil sehr großen Volumina zu „heben“. Hierbei handelt es sich vor allem um die Rekonstruktion der weiblichen Brust, der Thoraxwand, der Perineal- oder der Ilioinguinalregion. Trotz der grundsätzlich geringen Hebemorbidität dieser Lappen treten durch Muskel-/Faszienentnahme und die darauf einsetzende Schwächung der Bauchwand immer wieder Bauchwandhernien oder Vorwölbungen („Bulging“) auf. Diese finden sich gehäuft bei den klassischen Lappentypen, die auf der Mitnahme des M. rectus abdominis basieren. Die Weiterentwicklung der Lappenplastiken hin zu mikrovaskulär transferierten Lappen, insbesondere durch Perforatorlappen, führte zu einer Senkung der Hebemorbidität. In dieser Übersichtsarbeit sollen die Probleme und Therapiemöglichkeiten der durch Lappenentnahme induzierten Bauchwandschwächen dargestellt werden.

Abstract

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.

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Authors and Affiliations

  1. Klinik für Hand-, Plastische und Rekonstruktive Chirurgie – Schwerbrandverletztenzentrum – Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Plastische und Handchirurgie an der Universität Heidelberg, Ludwig-Guttmann-Straße 13, 67071 , Ludwigshafen

    G. Germann, M. Sauerbier & F. Unglaub

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  1. G. Germann
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  2. M. Sauerbier
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  3. F. Unglaub
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Correspondence to G. Germann.

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Germann, G., Sauerbier, M. & Unglaub, F. Bauchwandhernien als Folge von Hebedefekten nach abdominalen Lappenplastiken. Chirurg 77, 424–431 (2006). https://doi.org/10.1007/s00104-006-1183-6

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