Fallbericht einer Frontobasisrekonstruktion und Volumenkorrektur durch freie M. gracilis-Lappenplastik und autologe Fett-Transplantation – Die Lappenplastik als Scaffold für eine Fettgewebe-Transplantation

Zusammenfassung

Dieser Fallbericht zeigt die interdisziplinäre Behandlung einer 28-jährigen Patientin mit ausgeprägtem frontalen Volumendefekt nach schwerem Schädelhirntrauma. Durch die Kombination aus Schädeldachplastik mittels Polymethylmethacrylat (PMMA), freier M. gracilis-Lappenplastik und serieller Eigenfett-Transplantation in das transplantierte Muskelgewebe, konnte der Weichteildefekt ausgeglichen und eine ästhetische Rekonstruktion erzielt werden. Dieses Beispiel unterstreicht die Erweiterung des Behandlungsspektrums an interdisziplinären Exzellenzzentren durch Plastische Chirurgen, wodurch die Versorgung immer komplexerer Knochen-Weichteilläsionen möglich wird.

Abstract

This case report shows the interdisciplinary treatment of a 28-year-old woman suffering from a pronounced frontal volume defect after severe craniocerebral trauma. The combination of cranioplasty using a polymethylmethacrylate (PMMA) implant, free gracilis muscle flap transfer for soft tissue coverage and serial autologous fat grafting into the muscle flap for subsequent contouring enabled both an adequate and aesthetic reconstruction. This example demonstrates the feasibility of treating increasingly complex composite defects in a multidisciplinary setting, when plastic surgeons are involved.

Schlüsselwörter

Stirndefekt - Interdisziplinäre plastische Chirurgie - Mikrochirurgie - Lappenplastik als Scaffold - Autologe Fett-Transplantation

Key words

Forehead defect - interdisciplinary plastic surgery - microsurgery - free flap scaffold - autologous fat grafting

Publikationsverlauf

Eingereicht: 02. Februar 2020

Angenommen: 09. März 2020

Artikel online veröffentlicht:
21. August 2020

• Literaturverzeichnis

• 1 Ehrl D, Giunta R. Interdisciplinary Plastic Surgery – Chances, Conditions and Barriers of Reconstructive Microsurgery in Maximum Care Hospitals. Handchir Mikrochir Plast Chir 2019; 51: 284-294
• 2 Ripamonti U, Petit JC, Moehl T. et al. Immediate reconstruction of massive cranio-orbito-facial defects with allogeneic and alloplastic matrices in baboons. J Craniomaxillofac Surg 1993; 21: 302-308
• 3 Gladstone HB, McDermott MW, Cooke DD. Implants for cranioplasty. Otolaryngol Clin North Am 1995; 28: 381-400
• 4 Hicks DL, Watson D. Soft tissue reconstruction of the forehead and temple. Facial Plast Surg Clin North Am 2005; 13: 243-251 vi
• 5 Muresan C, Hui-Chou HG, Dorafshar AH. et al. Forehead reconstruction with microvascular flaps: utility of aesthetic subunits. Journal of reconstructive microsurgery 2012; 28: 319-326
• 6 Kruse-Losler B, Presser D, Meyer U. et al. Reconstruction of large defects on the scalp and forehead as an interdisciplinary challenge: experience in the management of 39 cases. Eur J Surg Oncol 2006; 32: 1006-1014
• 7 Isik S, Sahin I. Contour restoration of the forehead by lipofilling: our experience. Aesthetic Plast Surg 2012; 36: 761-766
• 8 Moss CJ, Mendelson BC, Taylor GI. Surgical anatomy of the ligamentous attachments in the temple and periorbital regions. Plast Reconstr Surg 2000; 105: 1475-1490 discussion 1491–1478
• 9 Mehrara BJ, Disa JJ, Pusic A. Scalp reconstruction. J Surg Oncol 2006; 94: 504-508
• 10 Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg 2005; 116: 54e-72e
• 11 Radovan C. Tissue expansion in soft-tissue reconstruction. Plast Reconstr Surg 1984; 74: 482-492
• 12 Eck DL, Koonce SL, Al Majed BM. et al. Evaluation of options for large scalp defect reconstruction: a 12-year experience. Eplasty 2014; 14: e10
• 13 Doscher M, Charafeddine AH, Schiff BA. et al. Superficial temporal artery and vein as recipient vessels for scalp and facial reconstruction: radiographic support for underused vessels. Journal of reconstructive microsurgery 2015; 31: 249-253
• 14 Goertz O, von der Lohe L, Martinez-Olivera R. et al. Microsurgical Reconstruction of Extensive Oncological Scalp Defects. Front Surg 2015; 2: 44
• 15 van Driel AA, Mureau MA, Goldstein DP. et al. Aesthetic and oncologic outcome after microsurgical reconstruction of complex scalp and forehead defects after malignant tumor resection: an algorithm for treatment. Plast Reconstr Surg 2010; 126: 460-470
• 16 Ooi A, Kanapathy M, Ong YS. et al. Optimising Aesthetic Reconstruction of Scalp Soft Tissue by an Algorithm Based on Defect Size and Location. Ann Acad Med Singapore 2015; 44: 535-541
• 17 Janus JR, Peck BW, Tombers NM. et al. Complications after oncologic scalp reconstruction: a 139-patient series and treatment algorithm. Laryngoscope 2015; 125: 582-588
• 18 Ehrl D, Brueggemann A, Broer N. et al. Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm. Journal of Neurological Surgery Part B: Skull Base. 2019
• 19 Fowler NM, Futran ND. Achievements in scalp reconstruction. Curr Opin Otolaryngol Head Neck Surg 2014; 22: 127-130
• 20 Broyles JM, Abt NB, Shridharani SM. et al. The fusion of craniofacial reconstruction and microsurgery: a functional and aesthetic approach. Plast Reconstr Surg 2014; 134: 760-769
• 21 Sosin M, Schultz BD, De La Cruz C. et al. Microsurgical scalp reconstruction in the elderly: a systematic review and pooled analysis of the current data. Plast Reconstr Surg 2015; 135: 856-866
• 22 Chou PY, Lin CH, Hsu CC. et al. Salvage of postcranioplasty implant exposure using free tissue transfer. Head Neck 2017; 39: 1655-1661
• 23 Engelhardt TO, Alghamdi HG, Wallmichrath J. et al. Free Gracilis Flap for Anatomic Reconstruction after Limb-sparing Sarcoma Resection. Handchir Mikrochir Plast Chir 2015; 47: 111-117
• 24 Huemer GM, Dunst KM, Maurer H. et al. Area enlargement of the gracilis muscle flap through microscopically aided intramuscular dissection: ideas and innovations. Microsurgery 2004; 24: 369-373
• 25 Ehrl D, Niclas Broer P, Heidekrueger PI. et al. Microsurgical Forehead Reconstruction. J Craniofac Surg 2017; 28: 212-217
• 26 Ono I, Tateshita T, Satou M. et al. Treatment of large complex cranial bone defects by using hydroxyapatite ceramic implants. Plast Reconstr Surg 1999; 104: 339-349
• 27 Cho HR, Roh TS, Shim KW. et al. Skull Reconstruction with Custom Made Three-Dimensional Titanium Implant. Arch Craniofac Surg 2015; 16: 11-16
• 28 Petersmann S, Spoerk M, Huber P. et al. Impact Optimization of 3D-Printed Poly(methyl methacrylate) for Cranial Implants. Macromolecular Materials and Engineering 2019; 304: 1900263
• 29 Lorea P, Vercruysse N, Coessens BC. Use of gracilis muscle free flap for reconstruction of chronic osteomyelitis of foot and ankle. Acta Orthop Belg 2001; 67: 267-273
• 30 Han DH, Park MC, Park DH. et al. Role of muscle free flap in the salvage of complicated scalp wounds and infected prosthetic dura. Arch Plast Surg 2013; 40: 735-741
• 31 Wettstein R, Largo RD, Raffoul W. et al. Laser scanning evaluation of atrophy after autologous free muscle transfer. Ann Plast Surg 2014; 72: 680-684
• 32 Kaariainen M, Kauhanen S. Skeletal muscle injury and repair: the effect of disuse and denervation on muscle and clinical relevance in pedicled and free muscle flaps. Journal of reconstructive microsurgery 2012; 28: 581-587
• 33 Chou CK, Lee SS, Lin TY. et al. Micro-autologous Fat Transplantation (MAFT) for Forehead Volumizing and Contouring. Aesthetic Plast Surg 2017; 41: 845-855
• 34 Niechajev I, Sevcuk O. Long-term results of fat transplantation: clinical and histologic studies. Plast Reconstr Surg 1994; 94: 496-506
• 35 Bellini E, Grieco MP, Raposio E. The science behind autologous fat grafting. Ann Med Surg (Lond) 2017; 24: 65-73
• 36 Delay E, Streit L, Toussoun G. et al. Lipomodelling: an important advance in breast surgery. Acta Chir Plast 2013; 55: 34-43
• 37 Santanelli di Pompeo F, Laporta R, Sorotos M. et al. Latissimus dorsi flap for total autologous immediate breast reconstruction without implants. Plast Reconstr Surg 2014; 134: 871e-879e
• 38 Niddam J, Vidal L, Hersant B. et al. Primary Fat Grafting to the Pectoralis Muscle during Latissimus Dorsi Breast Reconstruction. Plast Reconstr Surg Glob Open 2016; 4: e1059
• 39 Nelissen X, Lhoest F, Preud'Homme L. Refined Method of Lipofilling following DIEP Breast Reconstruction: 3 D Analysis of Graft Survival. Plast Reconstr Surg Glob Open 2015; 3: e526