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Möglichkeiten und Ergebnisse der (freien) vaskularisierten Knochentransplantation im Handbereich

Possibilities and results of (free) vascularized bone graft of the hand and wrist

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Zusammenfassung

Die vaskularisierten Knochentransplantate stellen bei Knochendefekten im Handbereich ein modernes, erfolgreiches Behandlungskonzept dar. Sie zeigen eine schnellere Einheilung und höhere Einheilungsrate, eine frühere und höhere mechanische Belastbarkeit sowie eine verbesserte Anpassung an neue mechanische Gegebenheiten. Die Indikation ist jedoch für ein optimales Ergebnis kritisch zu stellen.

Die Rekonstruktion der Knochendefekte sollte so früh wie möglich nach Trauma, Infektion oder Tumorresektion erfolgen. Amputationen sollten stets als Mittel der letzten Wahl eingesetzt werden.

Das vaskularisierte Knochentransplantat wird je nach Knochendefekt ausgewählt. Es stehen zahlreiche verschiedene Spenderregionen, wie Fibula, Skapula, Radius, Ulna, Femur und Beckenkamm zur Verfügung. Jede Entnahmeregion hat verschiedene Vor- und Nachteile für die Patienten, die sorgfältig diskutiert werden müssen. Um optimale postoperative Ergebnisse erzielen zu können, ist die umfassende Kenntnis dieser Spenderregionen Voraussetzung. Daher sollten diese Operationen in mikrovaskulär ausgerichteten plastisch-chirurgischen oder handchirurgischen Schwerpunktzentren durchgeführt werden.

Abstract

The vascularized bone transplantation or graft is a modern and successful treatment concept in segmental bone loss. Faster healing and higher union rates were shown in several studies. Using vascularized bone grafts, the adaption in mechanical conditions as well as stability are improved. The indications, however, must be critically considered in order to obtain an optimal result. Reconstruction of the bone defect should be performed as quickly as possible after the trauma, infection, or tumor resection. Amputation should always remain the method of last choice. Depending on the existing bone defect, there are various possible donor sites, e.g., fibula, scapula, ulna, femur, and hip bone. The advantages and disadvantages of each donor site has to be thoroughly discussed prior to the operation to assure an optimal postoperative result. In view of these issues, vascularized bone grafts should be performed in microvascular specialized plastic or hand surgery centers.

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  1. Klinik für Plastische-, Hand- und Rekonstruktive Chirurgie; Kliniken des Main-Taunus-Kreises GmbH - Kooperationsklinik für Plastische Chirurgie des Universitätsklinikums Frankfurt, Akademisches Lehrkrankenhaus der Johann Wolfgang Goethe-Universität Frankfurt am Main, Kronbergerstr. 36, 65812, Bad Soden am Taunus, Deutschland

    L. Just-Kovač &  M. Sauerbier

  2. Division of Hand Surgery and Reconstructive Microsurgery, Azienda Ospedaliera Careggi, C.T.O., Florence, Italy

    M. Innocenti

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  1. L. Just-Kovač
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  2. M. Innocenti
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Correspondence to M. Sauerbier.

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Just-Kovač, L., Innocenti, M. & Sauerbier, M. Möglichkeiten und Ergebnisse der (freien) vaskularisierten Knochentransplantation im Handbereich. Obere Extremität 6, 189–198 (2011). https://doi.org/10.1007/s11678-011-0130-4

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