Kombinierte Lappenplastiken aus der medio-distalen Oberschenkelregion: Anatomische Besonderheiten, klinische Aspekte, neue Applikationen

Zusammenfassung

Die Fortschritte in der plastisch-rekonstruktiven Chirurgie ermöglichen mittlerweile eine nahezu vollständige funktionelle und ästhetische Wiederherstellung nach schweren Verletzungen. Als besonders schwierig gestaltet sich allerdings die Rekonstruktion von Kombinationsdefekten mit Beteiligung verschiedener Gewebskomponenten. Hierfür werden kombinierte Lappenplastiken mit verschiedenen Gewebskomponenten aus einer adäquaten Spenderregion benötigt. Vor diesem Hintergrund haben wir uns aus anatomischer und klinischer Sicht mit Lappenplastiken aus dem Bereich des medialen Femurkondylus befasst. In der vorliegenden Arbeit werden verschiedene Möglichkeiten aus dieser Region unter Berücksichtigung anatomischer Besonderheiten beschrieben. Hierbei werden die Ergebnisse unserer eigenen anatomischen Studie sowie unserer bereits gesammelten klinischen Erfahrungen mit vorangegangener Literatur zu diesem Thema in Kontext gesetzt.

Als versorgendes Gefäß diente hierbei die A. genus descendens mit ihren Ästen. Neben einer konstanten Gefäßlänge und -durchmesser bietet die A. genus descendens eine stetige Aufteilung in ­einen periostalen, kutanen und muskulären Ast. Durch diese Konstellation bietet dieses Spenderareal zuverlässig verschiedene Möglichkeiten für individuell angepasste, kombinierte Lappenplastiken.

Abstract

Advances in plastic and reconstructive surgery allow an almost complete functional and aesthetic reconstruction after severe injuries. However, particularly the treatment of complex defects involving different tissue components is still challenging. The reconstruction requires a combined flap consisting of different tissues from an adequate donor area. In this context, we focused on anatomical and clinical aspects of transplants from the area of the medial femoral condyle. In this study, the anatomical characteristics and potentials of various flaps from the region of this region are described. Moreover, previous literature on this subject is put in context with both the results of our own anatomical study and our clinical experience.

The supplying vessel is the descending genicular artery with its branches. In addition to the consistency in vessel length and diameter, the descending genicular artery has a continuous distribution in a periosteal, cutaneous and muscular branch. Due to this anatomical characteristic, this donor site offers the possibility for several customized transplants.

Thus, the distal medial thigh is a versatile and reliable donor site for plastic surgical procedures.

Schlüsselwörter

Osteo-Myo-Kutane Lappen - Medialer Femurkondylus - Vaskularisierte Knochentransplantate - medio-distalen Oberschenkelregion - Kombinationsdefekten

Key words

osteomyocutaneous flaps - medial femoral condyle - vascularised bone graft - distal medial thigh - complex defects

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