Plastisch-chirurgische Versorgung von Leistendefekten bei infizierten Gefäßprothesen: Managementstrategien und praxisorientierter Algorithmus

Zusammenfassung

Hintergrund

Infektionen von Gefäßprothesen im Leistenbereich stellen eine große chirurgische Herausforderung dar und sind mit einer hohen Morbidität und Mortalität vergesellschaftet. Die komplexe Anatomie und hohe bakterielle Besiedlungsdichte erschweren die Versorgung erheblich. Für die rekonstruktive Therapie sind individuelle und interdisziplinäre Strategien erforderlich.

Methoden

Mittels einer Literaturrecherche in PubMed und Cochrane Library wurden aktuelle Erkenntnisse und Empfehlungen in der rekonstruktiven Versorgung infizierter Gefäßprothesen erfasst und zusammengetragen. Der entwickelte Algorithmus berücksichtigt Defektgröße, Infektionsstatus und individuelle Patientenfaktoren.

Ergebnisse

Gestielte Lappenplastiken (z. B. M. sartorius oder M. gracilis) bieten durch ihre robuste Perfusion eine schnelle und unkomplizierte rekonstruktive Therapieoption. Für größere Defekte sind die transverse myokutane Gracilis-, die Rectus-femoris- und die ALT-Lappenplastik geeignet. Die prophylaktische Anwendung gestielter Lappen kann postoperative Wundheilungsstörungen, insbesondere bei Hochrisikopatienten, reduzieren.

Schlussfolgerung

Die Behandlung infizierter Leistendefekte erfordert eine individuelle und interdisziplinäre Planung und plastisch-chirurgische Therapie. Der vorgestellte Algorithmus bietet eine strukturierte Handlungsanweisung zur Verbesserung der Heilungsrate und zur Reduktion von Komplikationen.

Abstract

Purpose

Infections involving vascular prostheses in the groin region are a major surgical challenge, associated with substantial morbidity and mortality rates. The complex anatomical structures and high density of bacterial colonisation considerably complicate their surgical management. Consequently, reconstructive therapy demands individualised and interdisciplinary strategies to achieve optimal outcomes.

Methods

A systematic search was conducted using PubMed and the Cochrane Library to collect and evaluate current evidence and recommendations regarding the reconstructive management of infected vascular prostheses. The developed algorithm incorporated essential factors, such as defect size, infection severity, and patient-specific characteristics to guide therapeutic decision making.

Results

Pedicled flap techniques, particularly those employing the M. sartorius or M. gracilis, are rapid and reliable reconstructive solutions – due to their robust vascular supply. In cases of larger defects, the transverse myocutaneous gracilis (TMG), Rectus femoris, and anterolateral thigh (ALT) flaps proved to be suitable alternatives. Prophylactic use of pedicled flaps was associated with a reduction in postoperative complications, particularly in high-risk patients

Conclusion

The surgical management of deep groin infection requires meticulous individualised and interdisciplinary planning and plastic reconstructive experience. The proposed algorithm provides a structured and evidence-based framework to improve healing rates and minimise the risk of complications.

Schlüsselwörter

Gefäßprotheseninfektion - Leistenrekonstruktion - Leisteninfektion - Muskellappenplastik - Leistendefekt

Keywords

vascular graft infection - groin reconstruction - deep groin infection - muscle flap - groin defect

Publication History

Received: 31 March 2025

Accepted: 11 June 2025

Article published online:
21 July 2025

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