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Die 180º-Propellerlappenplastik zur Defektdeckung im Bereich des distalen Unterschenkels

Soft tissue reconstruction of the distal lower extremity using the 180-degree perforator-based propeller flap

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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Weichteildeckung mit lokalem, belastungsfähigem und dünnem Gewebe ohne Spalthauttransplantation und freiem, mikrochirurgischem Gewebetransfer.

Indikationen

Lappenpflichtige Defekte des distalen Unterschenkels und Sprunggelenks mit exponierten neurovaskulären Strukturen, Knochen, Gelenken und Sehnen bis maximal 6 cm Breite.

Kontraindikationen

Ischämie der Extremität (pAVK Stadien III oder IV), Diabetes mellitus, postthrombotisches Syndrom, Ulcus cruris, chronisches Lymphödem,ausgeprägte Kontusion der unteren Extremität, vorangegangene Bestrahlung sowie fehlende Perforatoren.

Operationstechnik

Drehpunkt des Lappens ist der Perforator. Lappenplanung um diesen Perforator, dann subfasziale Hebung des Lappens nach Darstellung des Gefäßes. Kurzstreckige Präparation des Gefäßstiels. Rotation des Lappens um 180º, somit Verschluss des distalen Defekts durch proximales Gewebe. Primärverschluss des Hebedefekts bis 6 cm Breite.

Nachbehandlung

Postoperative Elevation der Extremität für 5 Tage, dann Lappentraining.

Ergebnisse

In 17 Fällen wurde die Propellerlappenplastik zur Defektdeckung am distalen Unterschenkeldrittel verwendet. In einem Fall kam es bei einem Diabetiker zur Lappennekrose, welche schlussendlich zu einer Unterschenkelamputation führte. Bei einem weiteren Patienten kam es zu einer oberflächlichen Epidermolyse der Lappenspitze, die keine weitere Intervention erforderte.

Abstract

Objective

Operative technique of propeller flap reconstruction of soft tissue defects in the distal lower extremity. Soft tissue reconstruction of the distal third of the lower extremity with local, reliable perforator flaps avoiding free tissue transfer.

Indications

Complex wounds (maximum width of 6 cm) of the distal lower extremity with exposed bones, joints, tendons, and neurovascular structures.

Contraindications

Arterial vascular disease (stage III or IV), diabetes mellitus, postthrombotic syndrome, venous ulcers, chronic lymphedema, contusion of adjacent soft tissue, previous radiation, and lack of perforators

Surgical technique

The perforator represents the pivot point around which rotation of up to 180º of the subfascially harvested flap allows closure of the defect. The proximal donor site can be closed primarily up to a width of 6 cm.

Postoperative management

Strict elevation of the extremity for 5 days, then flap conditioning.

Results

This technique was used for soft tissue reconstruction in 17 patients. In one patient with diabetes, complete flap necrosis occurred, requiring amputation of the extremity. One case of epidermolysis healed without further surgery.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Uniklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland

    R.G. Jakubietz, K. Schmidt, B.M. Holzapfel, R.H. Meffert & M.G. Jakubietz

  2. Orthopädische Klinik König-Ludwig-Haus, Universität Würzburg, Würzburg, Deutschland

    B.M. Holzapfel & M. Rudert

Authors
  1. R.G. Jakubietz
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  2. K. Schmidt
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  3. B.M. Holzapfel
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  4. R.H. Meffert
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  5. M. Rudert
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  6. M.G. Jakubietz
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Corresponding author

Correspondence to R.G. Jakubietz.

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Jakubietz, R., Schmidt, K., Holzapfel, B. et al. Die 180º-Propellerlappenplastik zur Defektdeckung im Bereich des distalen Unterschenkels. Oper Orthop Traumatol 24, 43–49 (2012). https://doi.org/10.1007/s00064-011-0090-2

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  • DOI: https://doi.org/10.1007/s00064-011-0090-2

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