Rekonstruktion von tumorbedingten Defekten in der Kopf-Hals-Chirurgie mit individualisierten dreidimensionalen Lappen unter Anwendung der Vakuumtherapie

Zusammenfassung

Trotz der Weiterentwicklungen funktionserhaltender multimodaler Tumorkonzepte in der onkologischen Kopf-Hals-Chirurgie stellen große und funktionelle Defekte nach radikaler Tumorresektion noch immer eine Herausforderung für den Chirurgen dar. Individuell präfabrizierte freie Lappenplastiken können mit der computer-kontrollierten kontinuierlichen Vakuumtherapie gezielt hergestellt werden, um die jeweiligen funktionellen Defekte zu ersetzen. Dieses beschleunigt die Präfabrikation dreidimensionaler Lappenplastiken und erhöht die Sicherheit des Verfahrens. Veränderungen der genuinen Struktur solcher Lappen werden durch die Implantation von auto- oder heterologen Transplantaten, alleine oder in Kombination mit alloplastischen Materialien als Stützelemente erzielt. Die Anwendung der Vakuumtherapie hilft dabei, den Prozess der Präfabrikation durch die Induktion der Angiogenese zu beschleunigen. Neben der kontinuierlichen Sekretableitung und Verhinderung der sekundären Kompression durch Gewebeschichten durch Hämatome oder Serome wird die Modellierung des dreidimensionalen Konstruktes unterstützt. Diese Arbeit beschreibt die Technik der Vakuumtherapie zur Präfabrikation dreidimensionaler gestielter oder freier Lappenplastiken zur Rekonstruktion von Tumordefekten nach onkologischen Resektionen im Kopf-Hals-Bereich.

Abstract

Despite recent developments in oncologic head and neck surgery extensive tissue and functional defects following radical tumor resections remains a surgical challenge. Individually prefabricated free flaps to meet the needs of the functional defect can be generated with the help of continuous computer-assisted vacuum therapy. This accelerates the prefabrication of three-dimensional composite flaps and enhances therapeutic safety. Changes of the geniuine structure of such flaps are induced by implantation of autologous or heterologous transplants alone or in combination with alloplastic materials as a supportive element. Application of vacuum therapy is useful to accelerate the process of prefabrication by the induction of angiogenesis. Besides this the continuous removal of wound exudate, possible seroma or haematoma and secondary compression of the different tissue layers improve the modelling of the three-dimensional construct. This article describes the technique of vacuum therapy for the prefabrication of three-dimensional pedicled or free flaps for reconstruction of defects after tumor resection in the head and neck area.

Schlüsselwörter

Lappenpräfabrikation - Tumordefektrekosntruktion - Vakuumtherapie - Gesicht-Hals-Tumoren

Key words

prefabrication of flaps - reconstruction of tumor defects - vacuum therapy - head and neck tumors

Literatur

• 1 Abbase E A, Shenaq S M, Spira M. et al . Prefabricated flaps: experimental and clinical review.  Plast Reconstr Surg. 1995;  96 1218-1225
• 2 Argenta L C, Morykwas M J. Vacuum assisted closure: a new methodfor wound control and treatment: clinical experience.  Ann Plast Surg. 1997;  38 563-576
• 3 Bayati S, Russell R C, Roth A C. Stimulation of angiogenesis to improve the viability of prefabricated flaps.  Plast Reconstr Surg. 1998;  101 290-1295
• 4 Chen H C, Kuo Y R, Hwang T L, Chen H H, Chang C H, Tang Y B. Microvascular prefabricated free skin flaps for esophageal reconstruction in difficult patients.  Ann Thorac Surg. 1999;  67 911-916
• 5 Delaere P R, Hardillo J, Hermans R, Van Den Hof B. Prefabrication of composite tissue for improved tracheal reconstruction.  Ann Otol Rhinol Laryngol. 2001;  110 849-860
• 6 Durate A, Valaurii F A, Buncke H J. Creating a free muscle flap by neovascularization: An experimental investigation.  J Reconstr Microsurg. 1987;  4 415-418
• 7 Fleischmann W, Becker U, Lang E. Vakuumversiegelung zur Behandlung des traumatischen Weichteilschadens am Oberschenkel.  Osteo Int. 1995;  2 2
• 8 Haws M J, Erdman D, Bayati S, Brown R E, Russell R C. Basic fibroblast growth factor induced angiogenesis and prefabricated flap survival.  J Reconstr Microsurg. 2001;  17 39-42
• 9 Hicky M J, Wilson Y, Hurley J V. et al . Mode of vascularization of control and basic fibroblast growth factor-stimulated prefabricated skin flaps.  Plast Reconstr Surg. 1998;  101 1296-1304
• 10 Hirai T, Manders E K, Hughes K. et al . Experimental study of allogenically vascularized prefabricated flaps.  Ann Plast Surg. 1996;  37 394-399
• 11 Horch R E. Editorial „Vakuumversiegelung”.  J Wound Healing. 2000;  5 3
• 12 Horch R E, Andree C, Walgenbach K J, Voigt M, Bannasch H, Stark G B. Vacuum assisted closure for coverage of extensive soft tissue defects and skin graft-fixation.  J Wound Healing. 2000;  5 17-19
• 13 Horch R E, Meyer-Marcotti M, Stark G B. Preexpansion of the tensor fasciae latae for free flap transfer.  Plast Reconstr Surg. 1998;  102 1188-1192
• 14 Horch R E, Stark G B. Prosthetic vascular graft infection-defect covering with delayed vertical rectus abdominis muscular flap (VRAM) and rectus femoris flap.  VASA. 1994;  23 52-56
• 15 Horch R E, Stark G B, Kopp J, Spilker G. Clinical experiences and histological findings with overgraft and sandwich-technique.  BURNS. 1993;  19 558-561
• 16 Hunt T K. The physiology of wound healing.  Ann Emerg Med. 1988;  17 1265-1273
• 17 Jiao X Y, Tanczos E, Dodic T, Voigt M, Haberstroh J, Stark G B. Prefabrication of bilaminar-epithelialized composite flap with tissue expander and cultured keratinocytes.  Plast Reconstr Surg. 1999;  103 138-144
• 18 Khouri R K, Upton J, Shaw W W. Principles of flap prefabrication.  Clin Plast Surg. 1992;  19 763-771
• 19 Li Q F, Reis E D, Zhang W X. Accelerated flap prefabrication with vascular endothelial growth factor.  J Reconstruct Microsurg. 2000;  16 45-49
• 20 Li Q F, Reis E D, Zhang W X, Silver L, Fallon J T, Weinberg H. Accelerated flap prefabrication with vascular endothelial growth factor.  J Reconstr Microsurg. 2000;  16 45-49
• 21 Maitz P K, Pribaz J J, Hergrueter C A. Impact of tissue expansion on flap prefabrication: an experimental study in rabbits.  Microsurgery. 1996;  17 35-40
• 22 Morykwas M J, Argenta L C, Shelton-Brown E I, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation.  Ann Plast Surg. 1997;  38 553-562
• 23 Morykwas M J, David L R, Schneider A M. et al . Use of subatmospheric pressure to prevent progression of partial-thickness burns in a swine model.  J Burn Care Rehabil. 1999;  20 15-21
• 24 Morykwas M J, Kennedy A, Argenta J P, Argenta L C. Use of subatmospheric pressure to prevent doxorubicin extravasation ulcers in a swine model.  J Surg Oncol. 1999;  72 14-17
• 25 Pribaz J J. Microsurgical Replantation of the Amputated Nose.  Plast Reconstr Surg. 2000;  105 2138-2139
• 26 Pribaz J J, Fine N, Orgill D P. Flap prefabrication in the head and neck: a 10-year experience.  Plast Reconstr Surg. 1999;  103 808-820
• 27 Pribaz J J, Fine N A. Prelamination: Defining the prefabricated flap. A case report and review.  Microsurgery. 1994;  15 618-623
• 28 Pribaz J J, Fine N A. Prefabricated and prelaminated flaps for head and neck reconstruction.  Clin Plast Surg. 2001;  28 261-272
• 29 Pribaz J J, Weiss D D, Mulliken J B, Eriksson E. Prelaminated free flap reconstruction of complex central facial defects.  Plast Reconstr Surg. 1999;  104 357-365
• 30 Rohner D, Bucher P, Kunz C, Hammer B, Schenk R K, Prein J. Treatment of severe atrophy of the maxilla with the prefabricated free vascularized fibula flap.  Clin Oral Implants Res. 2002;  13 44-52
• 31 Safak T, Akyurek M, Ozcan G, Kecik A, Aydin M. Osteocutaneous flap prefabrication based on the principle of vascular induction: an experimental and clinical study.  Plast Reconstr Surg. 2000;  105 1304-1313
• 32 Schipper J, Ridder G J, Maier W, Horch R E. The preconditioning and prelamination of pedicled and free microvascular anastomised flaps with the technique of vacuum assisted closure.  Laryngorhinootologie. 2003;  82 421-427
• 33 Shen T Y. Microvascular transplantation of prefabricated free thigh flap.  Plast Reconstr Surg. 1982;  69 568
• 34 Vogelin M DE, Jones N F, Lieberman J R, Baker J M, Tsingotjidou A S, Brekke J H. Prefabrication of bone by use of a vascularized periosteal flap and bone morphogenetic protein.  Plast Reconstr Surg. 2002;  109 190-198
• 35 Walgenbach K J, Rhiabikhin A W, Bannasch H, Galla T, Bach A, Andree C, Voigt M, Stark G B, Horch R E. Die Vakuumversiegelung in der Behandlung chronischer Wunden - Vacuum sealing in the treatment of chronic wounds.  J Wound Healing/Z Wundheilung. 2000;  5 6-8
• 36 Weihe S, Wehmoller M, Tschakaloff A, Oepen R, Schiller C, Epple M, Eufinger H. Alternative bone replacement substances for preoperative design of individual CAD/CAM skull implants.  Mund Kiefer Gesichtschir. 2001;  5 299-304
• 37 Yao S T. Microvascular transplantation of a prefabricated free thin flap.  Plast Reconstr Surg. 1982;  69 568