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Kombinierter Split-ALT/TFL-Lappen zur Deckung großer Defekte im Thoraxbereich

Combined split ALT/TFL flap for soft tissue coverage in large thoracical defects

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Zusammenfassung

Hintergrund

Große ulzerierende Tumoren im Thoraxbereich erfordern nach Resektion eine plastische Deckung. Je nach Lokalisation und Ausdehnung erfolgt dies meist durch gestielte Latissimus dorsi, oder VRAM/TRAM-Lappen. Bei besonders großen Defekten steht mit dem kombinierten Split-ALT/TFL-Lappen eine neue Technik zur Defektdeckung zur Verfügung.

Material und Methoden

Bei 4 Patienten (3 Frauen, 1 Mann) war nach Resektion eines Tumors im Thoraxbereich eine Defektdeckung notwendig. Das durchschnittliche Alter betrug 54 Jahre. Die durchschnittliche Defektgröße betrug 656 cm2.

Ergebnisse

In 3 Fällen erfolgte die Defektdeckung durch einen einseitig kombinierten Split-ALT/TFL-Lappen, in einem Fall doppelseitig. Alle Lappenplastiken heilten komplett ein. Der Verschluss der Hebestelle erfolgte teils primär, bei 3 Hebestellen war ein kleines Spalthauttransplantat notwendig.

Schlussfolgerung

Die Indikation für diese kombinierte ALT/TFL-Lappenplastik sind Defekte, die aufgrund ihrer Größe durch einen Lappen allein nicht zu rekonstruieren sind. Die Kombination von beiden schon lange bekannten Lappen an einem Gefäßstiel stellt eine neue Entwicklung dar.

Abstract

Background

Large, ulcerating tumors of the chestwall require soft tissue coverage after resection. Depending on size and location usually a latissimus dorsi flap, VRAM or TRAM flap is performed. In very large defects a combined split ALT/TFL flap is a new technique for coverage.

Patient and methods

In 4 patients (3 female, 1 male) a soft tissue reconstruction after tumor resection was necessary. The mean age was 54 years. The mean size of the defect was 656 cm2.

Results

In 3 cases the coverage was achieved by a unilateral, and in 1 case a bilateral combined split ALT/TFL flap. All flaps healed without flap loss. The donor site closure was achieved primarily in 2 cases. In 3 cases a small split skin graft was needed.

Conclusion

The indications for combined split ALT/TFL flaps are large defects which cannot be covered by one single flap. The combination of these two long-known flaps on one pedicle is a new development.

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Authors and Affiliations

  1. Ethianum Klinik Heidelberg, Vossstr. 6, 69115, Heidelberg, Deutschland

    M. Pelzer, G. Germann, C. Czermak & M. Reichenberger

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  1. M. Pelzer
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  2. G. Germann
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  3. C. Czermak
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  4. M. Reichenberger
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Correspondence to M. Pelzer.

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Pelzer, M., Germann, G., Czermak, C. et al. Kombinierter Split-ALT/TFL-Lappen zur Deckung großer Defekte im Thoraxbereich. Chirurg 85, 42–45 (2014). https://doi.org/10.1007/s00104-013-2547-3

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  • DOI: https://doi.org/10.1007/s00104-013-2547-3

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