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Prinzipien und Möglichkeiten der Rekonstruktion mit mikrochirurgischen Lappenplastiken

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Zusammenfassung

Mikrochirurgische Rekonstruktionen sind heute integraler Bestandteil komplexer plastisch-chirurgischer Rekonstruktionen, vor allem im Bereich Trauma, Tumorrekonstruktion und Korrektur kongenitaler Missbildungen. Den gestiegenen Anforderungen der Patienten an Funktion und Ästhetik der Lappenplastiken wird mit immer neuen Entwicklungen und Verbesserungen des Lappendesigns Rechnung getragen, die gleichzeitig auch für eine deutliche Verminderung der Hebedefektmorbidität sorgen. Die mittlerweile verfügbaren Konzepte und die immer weiter reduzierten Komplikationsraten machen mikrochirurgische Rekonstruktionsmöglichkeiten heute zu einem Therapieverfahren der 1. Wahl und nicht wie früher oft postuliert zu einem Instrument der "letzten Verteidigungslinie".

Abstract

Microsurgical reconstructions are considered an integral art of modern reconstructive concepts, especially in the fields of trauma, tumor reconstruction, and correction of congenital deformities. Patient expectations regarding function and aesthetics of plastic surgical reconstructions are satisfied with permanently improved flap designs that also lead to a significant reduction in donor site morbidity. Together with steadily decreasing complication rates, these options have made microsurgical reconstructions a prime choice in plastic surgery, in contrast to the past, where they were considered the "last line of defense."

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Literatur

  1. Al Quattan MM, Bowen V (1993) Effect of pre-existing health conditions on the results of reconstructive microvascular surgery. Microsurg 14(3): 152–157

  2. Albertengo JG, Rodriguez A, Buncke HJ, Hall EJ (1981) A comparative study of flap survival rates in end-to-end and end-to-side microvascular anastomoses. Plast Reconstr Surg 67:194

  3. Allen RJ, Treece P (1984) Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 32:32–38

  4. Allen RJ, Tucker C (1995) Superior gluteal artery perforator free flap for breast reconstruction. Plast Reconstr Surg 95:1207–1212

  5. Angrigiani C, Grilli D, Siebert J (1995) Latissimus dorsi musulocutaneous flap without muscle. Plast Reconstr Surg 96:1608–1614

  6. Arner M, Moller K (1994) Morbidity of the pedicled groin flap. A retrospective study of 44 cases. Scand J Plast Reconstr Surg Hand Surg 28(29): 143–146

  7. Atiyeh BS, Khali IM, Hussein MK, Al Amm CA, Musharafieh RS (2001) Temporary arteriovenous fistula and microsurgical free tissue transfer for reconstruction of complex defects. Plast Reconstr Surg 108(2): 485–488

  8. Barwick WJ, Goodkind DJ, Serafin D (1982) The free scapular flap. Plast Reconstr Surg 69:779

  9. Baudet J, LeMaire JM, Guimberteau JC (1976) Ten free groin flaps. Plast Reconstr Surg 57:577

  10. Baudet J, Guimberteau JC, Nascimento E (1976) Successful clinical transplant of two free thoracodorsal axillary flaps. Plast Reconstr Surg 58:680–688

  11. Baudet J (1979) Reconstruction of the pharyngeal wall by free transfer of the greater omentum and stomach. Int J Microsurg 1: 53–59

  12. Baumeister S, Germann G (2001) Soft tissue coverage of the extremly traumatized foot and ankle. Foot Ankle Clin 6(4): 867–903

  13. Bayramicli M, Tektik C, Sonmez A, Gurunluoglu R, Baltaci F (2002) Reliability of primary vein grafts in lower extremity free tissue transfer. Ann Plast Surg 48(1):21–29

  14. Buncke HJ, Alpert BS, Gordon L (1982) Serratus anterior microvascular transplantation. Presentation at the American Assosiation of Plastic Surgeons May 18 1982, 61st Annual Meeting, Colorado Springs, Colorado

  15. Chuang DC, Chen HC, Wie FC, Noordhoff MS (1992) Compound functioning free muscle flap transplantation (lateral half of soleus, fibula and skin flap). Plast Reconstr Surg 89(2): 335–339

  16. Daniel RK, Taylor GI (1973) Distant transfer of an island flap by mikrovascular arterial anastomosis: a clinical technique. Plast Reconstr Surg 52:111

  17. Daniel RK, May JW jr (1978) Free flaps: an overview. Clin Orthop 133:122–131

  18. Donaghy RMP, Yasargil MG (1967) Microvascular Surgery. C.V. Mosby Company, St. Louis Toronto London

  19. Duffy FJ, Pribaz JJ, Hergrueter CA, Maitz PK (1993) Flap prefabrication using an exteriorised vascular pedicle in a rabbit ear model. Br J Plast Surg 46(4): 279–284

  20. Esther WH, Bodde MD, Enrico de Visser MD et al. (2003) Donor-Site Morbidity after free vaskularized autogenous fibular transfer: Subjective and quantitative analyses. Plast Reconstr Surg 111:2237

  21. Evans GR, Black JJ, Robb GL et al. (1997) Adjuvant therapy: the effects on microvascular lower extremity reconstruction. Ann Plast Surg 39(2): 141–144

  22. Fairbanks GA, Hallock GG (2002) Facial reconstruction using a combined flap of the subscapular axis simultaneously including separate medial and lateral scapular vascularized bone grafts. Ann Plast Surg 49(1): 104–8

  23. Fassio E, Laulan J, Aboumoussa J, Senyuva C, Goga D, Ballon G (1999) Serratus anterior free fascial flap for dorsal hand coverage. Ann Plast Surg 43(1): 77–82

  24. Feller A-M, Galla TJ (1998) The deep inferior epigastric artery perforator flap. Clin Plast Surg 25:197–206

  25. Fukui A, Inada Y, Maeda M, Tamai S, Mizumoto S, Yajima H, Sempuku T (1989) Pedicled and "flow-through" venous flaps: clinical applications. J Reconstr Microsurg 5(3): 235–243

  26. Galla TJ, Lukas B, Feller AM (1999) Gestielter versus freier TRAM-Lappen zur Mammarekonstruktion. Handchir Microchir Plast Chir 31(2): 126–133

  27. Geishauser M, Staudenmaier RW, Biemer E (1998) Donor-site morbidity of segmental rectus abdominis muscle flap. Br J Plast Surg 51(8): 603–607

  28. Geldmacher J (1967) Zur Technik der zweizeitigen Sehnentransplantation. Chirurg 38(7):327–328

  29. Germann G, Steinau HU (1996) The clinical reliability of vein grafts in free-flap transfer. J Reconstr Microsurg 12(1): 11–17

  30. Germann G, Raff T, Schepler H, Wittemann M (1997) Salvage of an avascular thumb by arteriovenous flow reversal and a microvascular "kite" flap: case report. J Reconstr Microsurg 13(4):291–295

  31. Germann G, Pelzer M, Sauerbier M (1998) Vorfabrizierte Lappenplastiken ("Prefabricated flaps") Ein neues rekonstruktives Konzept. Orthopäde 27(7):451–456

  32. Germann G, Bickert B, Steinau HU, Wagner H, Sauerbier M (1999) Versatility and reliability of combined flaps of the subscapular system. Plast Reconstr Surg 103(5): 1386–1399

  33. Germann G, Busching K, Wittemann M (1999) Two modifications of the radial forearm flap for reconstruction of complex facial defects. J Reconstr Microsurg 15(7): 489–493

  34. Germann G, Brüner S (2001) Plastisch-chirurgische Rekonstruktion der Stammregion nach Resektion maligner Tumoren und deren Therapiefolgen. Chirurg 75(5): 514–522

  35. Germann G, Brüner S (2003) Compound flaps in upper extremity reconstruction. Duniz London, in press

  36. Gilbert A, Teot L (1982) The free scapular flap. Plast Reconstr Surg 69a: 601–604

  37. Gillies HD (1920) Plastic Surgery of the Face. Oxford University Press, London

  38. Gillies HD, Millard DR jr (1957) Principles and Art of Plastic Surgery. Little, Brown and Company, Boston

  39. Giunta R, Geisweid A, Lukas B, Feller AM (2000) Über die Perforans-Lappenplastik und ihre Anwendung in der Handchirurgie. Handchir Mikrochir Plast Chir 32:399–403

  40. Godina M (1979) Preferential use of end-to-side arterial anastomosis in free flap transfers. Plast Reconstr Surg 64:673

  41. Godina M (1986) Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 78(3): 285–292

  42. Godina M (1987) The tailored latissimus dorsi free flap. Plast Reconstr Surg 80:304

  43. Hamilton SGA, Morrison WA (1982) The scapular free flap. Br J Plast Surg 35:2

  44. Harii K (1978) Clinical application of free omental flap transfer. Clin Plast Surg 5(2): 273–81

  45. Harpf C, Gabl M, Reinhardt C et al. (2001) Small free vascularized iliac crest bone grafts in reconstruction of the scaphoid bone: a retrospective study in 60 cases. Plast Reconstr Surg 108(3): 66–74

  46. Harrison DH (1986) The osteocutaneus free fibular graft. J Bone Joint Surg 68B: 804

  47. Hasen KV, Few JW, Fine NA (2002) Plastic surgery: a component in the comprehensive care of cancer patients. Oncology 16(12): 1685–1698

  48. Hasen KV, Gallegos ML, Dumanian GA (2003) Extended Approach to the vascular pedicle of the gracilis muscle flap: anatomical and clinical study. Plast Reconstr Surg 111:2203

  49. Heitmann C, Pelzer M, Menke H, Germann G (2000) The free musculocutaneus tensor fascia lata flap as a backup procedure in tumor surgery. Ann Plast Surg 45(4): 399–404

  50. Hill HL, Nahai F, Vasconez LO (1978) The tensor fascia lata myocutaneus free flap. Plast Reconstr Surg 61:517–522

  51. Jacobson JH, Suarez EL (1960) Microsurgery in anastomosis of small vessels. Surg Forum 11:243

  52. Kat CC, Darcy CM, O`Donoghue JM, Taylor AR, Regan PJ (1999) The use of the latissimus dorsi flap for immediate correction of the deformity resulting from breast conservation surgery. Br J Plast Surg 52(5): 420–421

  53. Katsaros J, Schustermann M, Beppu M et al (1984) The lateral arm flap: anatomy and clinical applications. Ann Plast Surg 12:489

  54. Kimura N, Hasumi T, Satoh K (2001) Prefabricated thin flap using the transversalis fascia as a carrier. Plast Reconstr Surg 108(7): 1972–1980

  55. Koshima I, Inagawa K, Yamamoto M, Moriguchi T (2000) New microsurgical breast reconstruction using free paraumbilical perforator adiposal flaps. Plast Reconstr Surg 106(1):61–5

  56. Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S (2002) Perforator flaps in lower extremity reconstruction. Handchir Mikrochir Plast Chir 34(4): 251–256

  57. Koshima I, Urushibara K, Inagawa K, Moriguchi T (2001) Free tensor fasciae latae flap for the reconstruction of defects in the extremities. Plast Reconstr Surg 107(7): 1759–1765

  58. Mazzer N, Barbieri CH, Cortez M (1996) The posterior interosseus forearm island flap for skin defects in the hand and elbow. A prospective study of 51 cases. J Hand Surg [Br] 21(2): 237–243

  59. McCarthy WJ III, Matsumura JS, Fine NA, Dumanian GA, Pearce WH (1999) Combined arterial reconstruction and free tissue transfer for limb salvage. J Vasc Surg 29:814.

  60. McLean DH, Buncke HJ (1972) Autotransplant of omentum to a large scalp defect with microsurgical revascularization. Plast Reconstr Surg 49:268–274

  61. Nahai F, Mathes SJ (1984) Musculocutaneus flap or muscle flap and skin graft? Ann Plast Surg 12(2): 199–203

  62. O´Brien BM, MacLeod AM, Hayhurst JW, Morrison WA (1973) Successful transfer of a large island flap from the groin to the foot by microvascular anastomoses. Plast Reconstr Surg 52:271

  63. Olivari N (1976) The latissimus dorsi flap. Brit J Plast Surg 29:126

  64. Orticochea M (1972) The musculo-cutaneous flap method: An immediate and heroic substitute for the method of delay. Brit J Plast Surg 25:106

  65. Pennington D, Pelly AS (1980) The rectus abdominis myocutaneus free flap. Br J Plast Surg 33:277–282

  66. Pribaz JJ, Fine NA, Orgill DP (1999) Flap prefabrication in the head and the neck: a 10-year experience. Plast Reconstr Surg 103(3): 308–320

  67. Pribaz JJ, Fine NA (2001) Prefabricated and prelaminated flaps for head and neck reconstruction. Clin Plast Surg 28(2): 261–272

  68. Russell RC, Pribaz J, Zook EG, Leighton WD, Eriksson E, Smith CJ (1986) Functional evaluation of latissimus dorsi donor site. Plast Reconstr Surg 78(3):336–344

  69. Sauerbier M, Erdmann D, Bickert B, Wittemann M, Germann G (2001) Die Defektdeckung an Hand und Unterarm mit dem freien Skapula-Paraskapularlappen. Handchir Microchir Plast Chir 33(1): 20–25

  70. Serletti JM, Deuber MA, Guidera PM et al. (1995) Comparism of the operating microscope and loupes for free microvascular tissue transfer. Plast Reconstr Surg 95(2): 270–276

  71. Shimizu T, Ohno K, Matsuura M, Segawa K, Michi K (2002) An anatomical study of vascularized iliac bone graft for dental implantation. J Craniomaxillofac Surg 30(3). 184–188

  72. Simman R, Jackson IT, Andrus L (2002) Prefabricated buccal mucosa-lined flap in an animal model that could be used for vaginal reconstruction. Plast Reconstr Surg 109(3): 1044–1049

  73. Song R, Gao Y, Song Y, Yu Y, Song Y (1982) The forearm flap. Clin Plast Surg 9 :21–26

  74. Stock W, Biemer E, Mühlbauer W (1984) Der Unterarmlappen und seine unterschiedlichen Anwendungsmöglichkeiten. Handchir Microchir Plast Chir 16(3):201–203

  75. Takushima A, Harii K, Asato H (2002) Expanded latissimus dorsi free flap for the treatment of extensive post-burn neck contracture. J Reconstr Microsurg 18(5): 373–7

  76. Tamai S, Komatsu S, Sakamoto H, Sano S, Sasauchi N (1970) Free muscle transplants in dogs, with microsurgical neurovascular anastomoses. Plast Reconstr Surg 46(3): 219–225

  77. Tamai S (1978) Digital replantation. Clin Plast Surg 5:195

  78. Taylor GI, Miller GD, Ham FJ (1975) The free vascularized bone graft – a clinical extension of microvascular techniques. Plast Reconstr Surg 55:533–544

  79. Williams JK, Carlson GW, Howell RL et al. (1997) The tensor fascia lata free flap in abdominal wall reconstruction. J Reconstr Microsurg 13:83–90

  80. Yajima H, Tamai S, Kobata Y, Murata K, Fukui A, Takakura Y (2002) Vascularized composite tissue transfers for open fractures with massive soft-tissue defects in the lower extremities. Microsurg 22:114–119

  81. Zancolli EA und Angrigiani C (1988) Posterior interosseus island forearm flap. J Hand Surg [Br] 13(2): 130–135

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  1. Klinik für Hand, Plastische und Rekonstruktive Chirurgie, - Schwerbrandverletztenzentrum -, Plastische und Handchirurgie-Universität Heidelberg, BG-Unfallklinik, Ludwigshafen

    G. Germann & A. Flügel

  2. Klinik für Hand, Plastische und Rekonstruktive Chirurgie, - Schwerbrandverletztenzentrum -, Plastische und Handchirurgie- Universität Heidelberg, BG-Unfallklinik, Ludwig Guttmann Straße 13, 67071 , Ludwigshafen

    G. Germann

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Germann, G., Flügel, A. Prinzipien und Möglichkeiten der Rekonstruktion mit mikrochirurgischen Lappenplastiken. Chirurg 74, 790–801 (2003). https://doi.org/10.1007/s00104-003-0726-3

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