PDF herunterladen
Handchir Mikrochir Plast Chir 2020; 52(04): 330-334
DOI: 10.1055/a-1150-7601
Fallbericht

Fallbericht einer Frontobasisrekonstruktion und Volumenkorrektur durch freie M. gracilis-Lappenplastik und autologe Fett-Transplantation – Die Lappenplastik als Scaffold für eine Fettgewebe-Transplantation

Case report of frontobasal reconstruction and volume augmentation using a free gracilis muscle flap and autologous fat grafting: utilising the free flap as a scaffold for fat transplantation
Nicholas Möllhoff
1   Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
,
Konstantin Christoph Koban
1   Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
,
Timm Oliver Engelhardt
1   Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
,
Joerg Christian Tonn
2   Neurochirurgische Klinik und Poliklinik, LMU München
,
Riccardo E. Giunta
1   Abteilung für Hand-, Plastische und Ästhetische Chirurgie, Klinikum der Universität München, LMU München
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Dieser Fallbericht zeigt die interdisziplinäre Behandlung einer 28-jährigen Patientin mit ausgeprägtem frontalen Volumendefekt nach schwerem Schädelhirntrauma. Durch die Kombination aus Schädeldachplastik mittels Polymethylmethacrylat (PMMA), freier M. gracilis-Lappenplastik und serieller Eigenfett-Transplantation in das transplantierte Muskelgewebe, konnte der Weichteildefekt ausgeglichen und eine ästhetische Rekonstruktion erzielt werden. Dieses Beispiel unterstreicht die Erweiterung des Behandlungsspektrums an interdisziplinären Exzellenzzentren durch Plastische Chirurgen, wodurch die Versorgung immer komplexerer Knochen-Weichteilläsionen möglich wird.

Abstract

This case report shows the interdisciplinary treatment of a 28-year-old woman suffering from a pronounced frontal volume defect after severe craniocerebral trauma. The combination of cranioplasty using a polymethylmethacrylate (PMMA) implant, free gracilis muscle flap transfer for soft tissue coverage and serial autologous fat grafting into the muscle flap for subsequent contouring enabled both an adequate and aesthetic reconstruction. This example demonstrates the feasibility of treating increasingly complex composite defects in a multidisciplinary setting, when plastic surgeons are involved.

Schlüsselwörter

Stirndefekt - Interdisziplinäre plastische Chirurgie - Mikrochirurgie - Lappenplastik als Scaffold - Autologe Fett-Transplantation

Key words

Forehead defect - interdisciplinary plastic surgery - microsurgery - free flap scaffold - autologous fat grafting


Publikationsverlauf

Eingereicht: 02. Februar 2020

Angenommen: 09. März 2020

Artikel online veröffentlicht:
21. August 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literaturverzeichnis

  • 1 Ehrl D, Giunta R. Interdisciplinary Plastic Surgery – Chances, Conditions and Barriers of Reconstructive Microsurgery in Maximum Care Hospitals. Handchir Mikrochir Plast Chir 2019; 51: 284-294
    Thieme ConnectPubMedSuche in Google Scholar
  • 2 Ripamonti U, Petit JC, Moehl T. et al. Immediate reconstruction of massive cranio-orbito-facial defects with allogeneic and alloplastic matrices in baboons. J Craniomaxillofac Surg 1993; 21: 302-308
    CrossrefPubMedSuche in Google Scholar
  • 3 Gladstone HB, McDermott MW, Cooke DD. Implants for cranioplasty. Otolaryngol Clin North Am 1995; 28: 381-400
    CrossrefPubMedSuche in Google Scholar
  • 4 Hicks DL, Watson D. Soft tissue reconstruction of the forehead and temple. Facial Plast Surg Clin North Am 2005; 13: 243-251 vi
    CrossrefPubMedSuche in Google Scholar
  • 5 Muresan C, Hui-Chou HG, Dorafshar AH. et al. Forehead reconstruction with microvascular flaps: utility of aesthetic subunits. Journal of reconstructive microsurgery 2012; 28: 319-326
    Thieme ConnectPubMedSuche in Google Scholar
  • 6 Kruse-Losler B, Presser D, Meyer U. et al. Reconstruction of large defects on the scalp and forehead as an interdisciplinary challenge: experience in the management of 39 cases. Eur J Surg Oncol 2006; 32: 1006-1014
    CrossrefPubMedSuche in Google Scholar
  • 7 Isik S, Sahin I. Contour restoration of the forehead by lipofilling: our experience. Aesthetic Plast Surg 2012; 36: 761-766
    CrossrefPubMedSuche in Google Scholar
  • 8 Moss CJ, Mendelson BC, Taylor GI. Surgical anatomy of the ligamentous attachments in the temple and periorbital regions. Plast Reconstr Surg 2000; 105: 1475-1490 discussion 1491–1478
    PubMedSuche in Google Scholar
  • 9 Mehrara BJ, Disa JJ, Pusic A. Scalp reconstruction. J Surg Oncol 2006; 94: 504-508
    CrossrefPubMedSuche in Google Scholar
  • 10 Leedy JE, Janis JE, Rohrich RJ. Reconstruction of acquired scalp defects: an algorithmic approach. Plast Reconstr Surg 2005; 116: 54e-72e
    CrossrefPubMedSuche in Google Scholar
  • 11 Radovan C. Tissue expansion in soft-tissue reconstruction. Plast Reconstr Surg 1984; 74: 482-492
    CrossrefPubMedSuche in Google Scholar
  • 12 Eck DL, Koonce SL, Al Majed BM. et al. Evaluation of options for large scalp defect reconstruction: a 12-year experience. Eplasty 2014; 14: e10
    PubMedSuche in Google Scholar
  • 13 Doscher M, Charafeddine AH, Schiff BA. et al. Superficial temporal artery and vein as recipient vessels for scalp and facial reconstruction: radiographic support for underused vessels. Journal of reconstructive microsurgery 2015; 31: 249-253
    Thieme ConnectPubMedSuche in Google Scholar
  • 14 Goertz O, von der Lohe L, Martinez-Olivera R. et al. Microsurgical Reconstruction of Extensive Oncological Scalp Defects. Front Surg 2015; 2: 44
    CrossrefPubMedSuche in Google Scholar
  • 15 van Driel AA, Mureau MA, Goldstein DP. et al. Aesthetic and oncologic outcome after microsurgical reconstruction of complex scalp and forehead defects after malignant tumor resection: an algorithm for treatment. Plast Reconstr Surg 2010; 126: 460-470
    CrossrefPubMedSuche in Google Scholar
  • 16 Ooi A, Kanapathy M, Ong YS. et al. Optimising Aesthetic Reconstruction of Scalp Soft Tissue by an Algorithm Based on Defect Size and Location. Ann Acad Med Singapore 2015; 44: 535-541
    CrossrefPubMedSuche in Google Scholar
  • 17 Janus JR, Peck BW, Tombers NM. et al. Complications after oncologic scalp reconstruction: a 139-patient series and treatment algorithm. Laryngoscope 2015; 125: 582-588
    CrossrefPubMedSuche in Google Scholar
  • 18 Ehrl D, Brueggemann A, Broer N. et al. Scalp Reconstruction after Malignant Tumor Resection: An Analysis and Algorithm. Journal of Neurological Surgery Part B: Skull Base. 2019
    CrossrefPubMedSuche in Google Scholar
  • 19 Fowler NM, Futran ND. Achievements in scalp reconstruction. Curr Opin Otolaryngol Head Neck Surg 2014; 22: 127-130
    CrossrefPubMedSuche in Google Scholar
  • 20 Broyles JM, Abt NB, Shridharani SM. et al. The fusion of craniofacial reconstruction and microsurgery: a functional and aesthetic approach. Plast Reconstr Surg 2014; 134: 760-769
    CrossrefPubMedSuche in Google Scholar
  • 21 Sosin M, Schultz BD, De La Cruz C. et al. Microsurgical scalp reconstruction in the elderly: a systematic review and pooled analysis of the current data. Plast Reconstr Surg 2015; 135: 856-866
    CrossrefPubMedSuche in Google Scholar
  • 22 Chou PY, Lin CH, Hsu CC. et al. Salvage of postcranioplasty implant exposure using free tissue transfer. Head Neck 2017; 39: 1655-1661
    CrossrefPubMedSuche in Google Scholar
  • 23 Engelhardt TO, Alghamdi HG, Wallmichrath J. et al. Free Gracilis Flap for Anatomic Reconstruction after Limb-sparing Sarcoma Resection. Handchir Mikrochir Plast Chir 2015; 47: 111-117
    Thieme ConnectPubMedSuche in Google Scholar
  • 24 Huemer GM, Dunst KM, Maurer H. et al. Area enlargement of the gracilis muscle flap through microscopically aided intramuscular dissection: ideas and innovations. Microsurgery 2004; 24: 369-373
    CrossrefPubMedSuche in Google Scholar
  • 25 Ehrl D, Niclas Broer P, Heidekrueger PI. et al. Microsurgical Forehead Reconstruction. J Craniofac Surg 2017; 28: 212-217
    CrossrefPubMedSuche in Google Scholar
  • 26 Ono I, Tateshita T, Satou M. et al. Treatment of large complex cranial bone defects by using hydroxyapatite ceramic implants. Plast Reconstr Surg 1999; 104: 339-349
    CrossrefPubMedSuche in Google Scholar
  • 27 Cho HR, Roh TS, Shim KW. et al. Skull Reconstruction with Custom Made Three-Dimensional Titanium Implant. Arch Craniofac Surg 2015; 16: 11-16
    CrossrefPubMedSuche in Google Scholar
  • 28 Petersmann S, Spoerk M, Huber P. et al. Impact Optimization of 3D-Printed Poly(methyl methacrylate) for Cranial Implants. Macromolecular Materials and Engineering 2019; 304: 1900263
    CrossrefPubMedSuche in Google Scholar
  • 29 Lorea P, Vercruysse N, Coessens BC. Use of gracilis muscle free flap for reconstruction of chronic osteomyelitis of foot and ankle. Acta Orthop Belg 2001; 67: 267-273
    PubMedSuche in Google Scholar
  • 30 Han DH, Park MC, Park DH. et al. Role of muscle free flap in the salvage of complicated scalp wounds and infected prosthetic dura. Arch Plast Surg 2013; 40: 735-741
    Thieme ConnectPubMedSuche in Google Scholar
  • 31 Wettstein R, Largo RD, Raffoul W. et al. Laser scanning evaluation of atrophy after autologous free muscle transfer. Ann Plast Surg 2014; 72: 680-684
    CrossrefPubMedSuche in Google Scholar
  • 32 Kaariainen M, Kauhanen S. Skeletal muscle injury and repair: the effect of disuse and denervation on muscle and clinical relevance in pedicled and free muscle flaps. Journal of reconstructive microsurgery 2012; 28: 581-587
    Thieme ConnectPubMedSuche in Google Scholar
  • 33 Chou CK, Lee SS, Lin TY. et al. Micro-autologous Fat Transplantation (MAFT) for Forehead Volumizing and Contouring. Aesthetic Plast Surg 2017; 41: 845-855
    CrossrefPubMedSuche in Google Scholar
  • 34 Niechajev I, Sevcuk O. Long-term results of fat transplantation: clinical and histologic studies. Plast Reconstr Surg 1994; 94: 496-506
    CrossrefPubMedSuche in Google Scholar
  • 35 Bellini E, Grieco MP, Raposio E. The science behind autologous fat grafting. Ann Med Surg (Lond) 2017; 24: 65-73
    CrossrefPubMedSuche in Google Scholar
  • 36 Delay E, Streit L, Toussoun G. et al. Lipomodelling: an important advance in breast surgery. Acta Chir Plast 2013; 55: 34-43
    PubMedSuche in Google Scholar
  • 37 Santanelli di Pompeo F, Laporta R, Sorotos M. et al. Latissimus dorsi flap for total autologous immediate breast reconstruction without implants. Plast Reconstr Surg 2014; 134: 871e-879e
    CrossrefPubMedSuche in Google Scholar
  • 38 Niddam J, Vidal L, Hersant B. et al. Primary Fat Grafting to the Pectoralis Muscle during Latissimus Dorsi Breast Reconstruction. Plast Reconstr Surg Glob Open 2016; 4: e1059
    CrossrefPubMedSuche in Google Scholar
  • 39 Nelissen X, Lhoest F, Preud'Homme L. Refined Method of Lipofilling following DIEP Breast Reconstruction: 3 D Analysis of Graft Survival. Plast Reconstr Surg Glob Open 2015; 3: e526
    CrossrefPubMedSuche in Google Scholar