Aspekte der mikrochirurgischen Rekonstruktion an der unteren Extremität

Zusammenfassung

Der interdisziplinäre Therapieansatz zwischen Orthopäden/Traumatologen und Plastischen Chirurgen ist die Grundvoraussetzung für eine effiziente Defektdeckung im Rahmen der Rekonstruktion der unteren Extremität. Durch die enge Zusammenarbeit und die Verwendung lokaler, regionaler und freier mikrochirurgischer Transplantationen kann die Amputationsrate gering gehalten werden. Durch die Verbreitung der mikrochirurgischen Techniken und die Innovationen auf dem Gebiet einschließlich der Knochenrekonstruktion durch vaskularisierte Knochen und osteokutane Lappenplastiken hat die rekonstruktive Mikrochirurgie einen hohen Stellenwert erlangt. Im Vordergrund der Indikationsstellung stehen die Auswahl der Lappenplastik mit dem Ziel einer optimalen Funktion und Stabilität nach mikrochirurgischer Rekonstruktion sowie Patientenzufriedenheit und Lebensqualität. Durch die Verwendung sensibel innervierter Lappenplastiken kann die Patientenzufriedenheit gesteigert werden. Außerdem hat die zeitliche Koordination der Rekonstruk­tion einen Einfluss auf das Ergebnis der Rekon­struktion. Der Stellenwert der „Composite Tissue Allotransplantation-CTA“ für die Rekonstruktion der unteren Extremität muss in weiterführenden Studien noch geklärt werden.

Abstract

The interdisciplinary approach to lower extremity reconstruction between orthopaedic and plastic surgeons is the basis for an efficient soft-tissue coverage. The joint team and the transfer of local, regional and free flaps have been shown to reduce the rate of amputation. After the spread of microsurgical techniques and further innovations, e. g., bony reconstruction by vascularized bone grafts, microsurgery now plays an important role in lower extremity reconstruction. Main considerations for the microsurgical approach are the choice of flap type aiming at good functional results with a stable soft-tissue coverage. The use of innervated flaps and functioning muscle transfer have led to an increased patient satisfaction and quality of life. Timing of reconstruction has been shown to have an impact on the results of microsurgical reconstruction. The importance of “composite tissue allotransplantation – CTA” applied for lower extremity reconstruction has to be evaluated in further studies.

Schlüsselwörter

Algorithmus - Unterschenkelrekonstruktion - freie Lappenplastiken - gestielte Lappenplastiken - Perforans-Lappenplastiken

Key words

algorithm - lower limb reconstruction - free flaps - pedicled flaps - perforator flaps

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