Epifaszial verlagerte tiefe inferiore epigastrische Gefäße als Anschlussgefäße für die mikrochirurgische Rekonstruktion komplexer onkochirurgischer Defekte des Abdomens und des Oberschenkels

Zusammenfassung

Hintergrund Die Resektion großer Weichteilsarkome erfordert die Rekonstruktion mit freiem Gewebstransfer. Hierbei stellt die Selektion geeigneter Anschlussgefäße einen entscheidenden Faktor für den operativen Erfolg dar.

Patienten Wir berichten über vier Fälle mit sehr großen Tumoren und mit besonders komplexem anatomischem Bezug: zwei Sarkome in der Leiste mit Infiltration der Gefäß-Nervenstraße und zwei Sarkome in der Flanke mit ausgedehnter thorakoabdomineller und viszeraler Beteiligung. In allen Fällen erfolgten interdisziplinäre Operationen innerhalb eines multimodalen Therapieansatzes. In zwei Fällen wurde ein anterolateraler Oberschenkellappen (ALT) und in zwei ein myokutaner Latissimus Dorsi (LD) Lappen zur Defektdeckung benutzt. In allen Fällen erfolgte eine epifasziale Verlagerung der tiefen inferioren epigastrischen Gefäße zum mikrochirurgischen Gefäßanschluss.

Ergebnisse Die durchschnittliche Operationszeit betrug 694 ± 149 Minuten. Das mittlere Resektatgewicht war 3069 ± 1267 g. Drei Lappenplastiken heilten primär ein, in einem Fall kam es zu einer Spitzennekrose, welche operativ behandelt wurde.

Schlussfolgerung Die Verlagerung der tiefen inferioren epigastrischen Gefäßen nach epifaszial stellt in dieser selektionierten Gruppe eine gute Option zum Anschluss freier Lappen dar. Aufgrund der oberflächlichen Lage ist die Durchführung der Anastomose erleichtert. Insbesondere bei großen Defekten mit bestrahltem Lager erweitert diese technische Modifikation die rekonstruktiven Optionen.

Abstract

Background The resection of large soft-tissue sarcoma requires reconstruction with free flaps. The choice of recipient vessels is crucial for the success of surgery.

Patients We report four cases with large soft-tissue sarcomas with complex anatomical relationships: two tumors of the thigh surrounding the femoral neurovascular structures and two tumors of the abdomen with infiltration of the thorax and the abdomen. All cases received multimodal interdisciplinary treatment. The anterolateral thigh (ALT) flap and the latissimus dorsi (LD) flap were employed twice for defect coverage in this series. In all cases the deep inferior epigastric (DIE) vessels were transposed to the subcutaneous compartment and used as recipient vessels.

Results The mean duration of surgery was 694 ± 149 minutes. The mean weight of the tumor specimen was 3069 ± 1267 g. Three flaps healed primarily and one exhibited a minor necrosis, which was treated by excision and secondary suture. There were no cases of abdominal herniation due to the transposition of vessels.

Conclusion Transposition of DIE-vessels to the subcutaneus compartment is a good alternative for free flap revascularisation in this patient group. In this position, the vessels are easily accessed and used for microsurgery. This technical modification increases the reconstructive possibilities in large and previously irradiated surgical defects.

Schlüsselwörter

Weichteilsarkom - interdisziplinäre Plastische Chirurgie - freie Lappen - Rekonstruktion der Leiste und des Abdomens - Anschlussgefäße - Mikrochirurgie

Key words

soft-tissue sarcoma - interdisciplinary plastic surgery - free flaps - reconstruction of the thigh and the abdomen - recipient vessels - microsurgery

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