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Handchir Mikrochir Plast Chir 2014; 46(02): 116-120
DOI: 10.1055/s-0033-1351330
Fallbericht
© Georg Thieme Verlag KG Stuttgart · New York

Desmoidtumor an DIEP-Lappen Anastomose Eine seltene Komplikation nach Mammarekonstruktion

Desmoid Tumour around the DIEP Anastomosis – A Rare Complication after Breast Reconstruction
F. Cromme
1   Klinik für Plastische Chirurgie, Agaplesion Diakonieklinikum Hamburg gGmbH, Hamburg
,
S. Brüner
1   Klinik für Plastische Chirurgie, Agaplesion Diakonieklinikum Hamburg gGmbH, Hamburg
,
K. S. Wittig
1   Klinik für Plastische Chirurgie, Agaplesion Diakonieklinikum Hamburg gGmbH, Hamburg
,
S. Grzybowski
1   Klinik für Plastische Chirurgie, Agaplesion Diakonieklinikum Hamburg gGmbH, Hamburg
› Author Affiliations
Further Information

Publication History

eingereicht 19 March 2013

akzeptiert 16 July 2013

Publication Date:
28 April 2014 (online)

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Zusammenfassung

Desmoidtumore sind seltene, nicht-metastasierungsfähige, aber lokal aggressiv- und infiltrativ wachsende Tumore, die aus den Fibroblasten des Muskelgewebes, der Faszien und Aponeurosen proliferieren. Die Hauptlokalisation ist der Bauch.

Eine lokale Rezidivrate von bis zu 65% ist beschrieben.

Nach einer Brustrekonstruktion mittels einer Unterbauchhautfett-Lappenplastik (DIEP-Lappen) kam es zu einem progredienten Wachstum eines Desmoidtumors im Bereich der Gefäßana­stomose der DIEP-Lappenplastik. Im Bereich der Lappen-Hebestelle am Bauch war keine tumoröse Raumforderung nachweisbar. Aufgrund der Ausbreitung des Desmoidtumors konnte die Exzision nicht in sano erfolgen, ohne den Gefäßstiel der DIEP-Lappenplastik zu gefährden.

Ob ein primär lokales Wachstum im Anastomosenbereich oder eine Transposition dieser seltenen Tumorentität von abdominell ursächlich war, ist vor dem Hintergrund der Literatur zur diskutieren.

Bei dieser außergewöhnlichen Lokalisation eines Desmoidtumors kann es bei erneuter Größenzunahme notwendig werden, die DIEP-Lappenplastik zu resezieren, um eine R0- Situation zu erreichen.

Abstract

Abdominal desmoid tumors are so called non-metastatic tumors. They occur by proliferation of fibroblasts of muscle, fascia or aponeuroses. After breast reconstruction with a DIEP flap (Deep Inferior epigastric Artery Perforator Flap), a progressive growth of a desmoid tumor was seen around the DIEP-anastomosis. A total excision was not possible without compromising the vascular pedicle. With taking into account a recurrence rate up to 65% another operation is probably necessary. In this case the main vessels of the graft have to be cut out and a necrosis of the flap can or may appear.

Schlüsselwörter

Desmoidtumor - Mammarekonstruktion - DIEP Lappenplastik - Verlust freier Lappen - Gefäßanastomose

Key words

desmoid tumour - breast reconstruction - DIEP flap - free flap loss - vascular microanastomosis
 

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