Das Chimera-fabricata-Lappen-Konzept in der Replantationschirurgie von Fingern – eine Einführung

Zusammenfassung

Seit Beginn erfolgreicher mikrochirurgischer Fingerreplantationen Anfang der 60er Jahre des letzten Jahrhunderts zeigt sich eine Evolution in den Techniken zur Wiederherstellung der Durchblutung der amputierten Finger. Initial wurden bei den ersten Fingerreplantationen End-zu-End-Anastomosen der Arterien und Venen durchgeführt. Später wurden bei schwierigen Avulsionsverletzungen Gefäßinterponate – in erster Linie Veneninterponate –mit Erfolg eingesetzt. Diese Gefäßinterponate wurden bei gleichzeitigen Weichteilverlusten durch Lappenplastiken im Sinne von Durchflusslappen erweitert. Eine Weiterentwicklung der Techniken stellt die Replantation von amputierten Fingern mit Hilfe von fabrizierten chimären Lappenplastiken dar. Dabei wird der amputierte Finger noch vor der eigentlichen Replantation in Tabula, auf dem Operationstisch, mit den Gefäßen einer Lappenplastik mikrochirurgisch anastomosiert und erst dann diese Chimera fabricata als Konstrukt replantiert. Die bisher letzte Entwicklung ist die heterotope Replantation mit sekundärer Replantation als fabrizierte chimäre Lappenplastik. Wir beschreiben im Sinne einer Einführung 3 Fälle, bei welchen wir dieses Konzept der fabrizierten chimären Lappenplastik bei orthotopen Replantationen erfolgreich angewendet haben.

Abstract

Since microsurgical finger replantations started to be successfully performed at the beginning of the 1960 s, there has been an evolution in the techniques for restoring blood flow to the amputated fingers. Initially, end-to-end anastomoses were performed. Later on, vascular grafts – predominantly vein interpositional grafts – were successfully used for difficult avulsion injuries. These vascular grafts were extended by microvascular flaps in the form of flow-through flaps in cases with simultaneous soft tissue loss. A further development of these techniques has been achieved by the replantation of amputated fingers with the help of fabricated chimeric flaps. The amputated finger is anastomosed microsurgically with a flap “in tabula” before the actual replantation. Only then is the fabricated chimera replanted as a construct. The latest development so far is heterotopic replantation with secondary replantation in the form a fabricated chimeric flap. By way of introduction, we describe three cases in which we have successfully applied this concept of fabricated chimeric flap surgery for orthotopic thumb replantations.

Schlüsselwörter

Freie Lappenplastiken - Mikrochirurgie - Daumen - Replantation

Key words

Free flaps - microsurgery - replantation - thumb

Publication History

Received: 18 August 2020

Accepted: 21 December 2020

Article published online:
26 April 2021

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