Brustrekonstruktion mit freien TRAM oder DIEP Lappen – Was ist zeitgemäßer Standard?

Steffen U. Eisenhardt; Arash Momeni; Uwe von Fritschen; Raymund E. Horch; G. Björn Stark; Holger Bannasch; Yves Harder; Christoph Heitmann; Thomas Kremer; Ulrich M. Rieger; Ulrich Kneser

doi:10.1055/a-0631-9025

Handchirurgie · Mikrochirurgie · Plastische Chirurgie, Inhaltsverzeichnis

Handchir Mikrochir Plast Chir 2018; 50(04): 248-255
DOI: 10.1055/a-0631-9025

Consensus Statement

Brustrekonstruktion mit freien TRAM oder DIEP Lappen – Was ist zeitgemäßer Standard?

Konsensuspapier der Deutschen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und GefäßeBreast reconstruction with the free TRAM or DIEP flap – What is the current standard?Consensus Statement of the German Speaking Working Group for Microsurgery of the Peripheral Nerves and Vessels

Steffen U. Eisenhardt

¹Universitätsklinikum Freiburg, Klinik für Plastische und Handchirurgie.

,

Arash Momeni

²Stanford University Medical Center, Stanford, CA, Division of Plastic and Reconstructive Surgery.

,

Uwe von Fritschen

³Helios-Klinikum Emil von Behring, Berlin, Klinik für Plastische und Ästhetische Chirurgie.

,

Raymund E. Horch

⁴Universitätsklinikum Erlangen, Plastisch- und Handchirurgische Klinik.

,

G. Björn Stark

¹Universitätsklinikum Freiburg, Klinik für Plastische und Handchirurgie.

,

Holger Bannasch

¹Universitätsklinikum Freiburg, Klinik für Plastische und Handchirurgie.

,

Yves Harder

⁵Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano (ORL), Ente Ospedaliero Cantonale (EOC), Lugano, Schweiz.

,

Christoph Heitmann

⁶Praxis Heitmann & Fansa, Ästhetisch Plastische Chirurgie, München.

,

Thomas Kremer

⁷Klinikum St. Georg Leipzig, Klinik für Plastische und Handchirurgie mit Schwerbrandverletztenzentrum.

,

Ulrich M. Rieger

⁸Agaplesion Markus Krankenhaus, Klinik für Plastische und Ästhetische Chirurgie, Wiederherstellungs- und Handchirurgie.

,

Ulrich Kneser

⁹BG Unfallklinik Ludwigshafen, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum.

› Institutsangaben

Abstract

Zusammenfassung

Die Brustrekonstruktion mit freiem Gewebetransfer vom Unterbauch als (muskelsparende) TRAM oder DIEP Lappenplastik stellt das Standardverfahren der autologen Brustrekonstruktion dar. Durch operative Fortschritte ist es gelungen die Hebedefektmorbidität durch muskelsparende bzw. perforatorbasierte Techniken zu minimieren. Hier stellt sich die Frage, in wie weit dies als ein notwendiger Standard angesehen werden kann oder ob auch Lappenplastiken mit Muskelanteilen (MS-TRAM) noch als zeitgemäß anzusehen sind. In einem Konsensusworkshop der 3 Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) wurde die Datenlage kritisch geprüft und durch eine Expertengruppe ein Konsensus erarbeitet. Dieser beinhaltet neben den aktuellen Daten zu Lappensicherheit und Hebedefektmorbidität aus der Literatur auch ein aktuelles Meinungsbild der Expertengruppe bzgl. verschiedener technischer Details des operativen Vorgehens.

Abstract

The most common donor-site for autologous breast reconstruction is the abdomen. Over the past several decades technical advances have resulted in the development of flaps that have been associated with a progressive decrease in abdominal wall morbidity. However, controversy exists related to the differences between muscle-sparing (MS)-TRAM and deep inferior epigastric perforator (DIEP) flaps. Hence, the question which approach should be considered standard of care remains unanswered. To address this question the current literature and published evidence was critically reviewed and discussed by an expert panel at the 39th Annual Meeting of the German-speaking Society for Micro surgery of the Peripheral Nerves and Vessels (DAM). Based on this discussion a consensus statement was developed that incorporates contemporary data regarding postoperative complication rate, donor site morbidity, as well as expert opinion regarding technical details in autologous breast reconstruction with free TRAM and DIEP flaps

Schlüsselwörter

Mammarekonstruktion - Brustchirurgie - freie Lappenplastiken - Mikrochirurgie - Perforans-Lappenplastiken - Mamma - Körperregion und Anatomie - TRAM Lappen - DIEP Lappen

Key words

breast reconstruction - free flap grafts - perforator flap grafts - breast - TRAM flap - DIEP flap

Volltext

Referenzen

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