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Lokale Perforatorlappen

Local perforator flaps

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Lokale Lappenplastiken sind seit Jahrhunderten ein Operationsverfahren zur Rekonstruktion von Gewebedefekten. Obwohl schon vor mehr als 2000 Jahren mit der so genannten indischen Lappenplastik eine kutane Lappenplastik zur Nasenrekonstruktion durchgeführt wurde, wurden erst in der 2. Hälfte des 20. Jahrhunderts gezielt Lappenplastiken mit axialer Blutversorgung für Anwendungen in der rekonstruktiven Chirurgie beschrieben. Detaillierte Kenntnisse der Blutversorgung der Haut führten schließlich zur Entwicklung von Lappenplastiken, deren Durchblutung lediglich aus vertikal aufsteigenden Perforansgefäßen stammt. Diese so genannten Perforatorlappenplastiken wurden zunächst v. a. als mikrochirurgische freie Lappenplastiken eingesetzt, jedoch erlaubt die Stielung an einzelnen Perforansgefäßen auch den sicheren und effizienten Transfer großer Gewebseinheiten als lokale Lappenplastik in die entsprechende Defektregion. Im vorliegenden Beitrag sollen Techniken der lokalen Perforatorlappenplastik sowie verschiedene regionale Anwendungsmöglichkeiten dargestellt und Indikationen und mögliche Kontraindikationen herausgearbeitet werden.

Abstract

Local flaps are established procedures for reconstruction of skin and soft tissue defects. Although a cutaneous flap (the so-called Indian flap) had been applied more than 2000 years ago for reconstruction of nasal defects, axial pattern skin flaps for applications in reconstructive surgery were mainly developed in the second half of the twentieth century. Detailed knowledge of the vascular anatomy of the skin eventually led to development of a novel type of skin flap that entirely relies on perforating vessels. In the beginning these so-called perforator flaps were mainly used as microsurgical free flaps. However, the same concept also allows for safe and efficient transfer of large tissue volumes into given defects as a local pedicled flap. This article describes different technical aspects of local perforator flaps and provides examples for clinical applications in different regions. Specific Indications and contraindications of local perforator flaps are discussed in detail.

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Kneser, U., Beier, J., Dragu, A. et al. Lokale Perforatorlappen. Trauma Berufskrankh 13, 77–82 (2011). https://doi.org/10.1007/s10039-011-1722-3

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