Rekonstruktion von Defekten im Kopf-Hals-Bereich nach Tumorresektionen

Tumorresektionen im Kopf-Hals-Bereich resultieren aufgrund der engen anatomischen Lagebeziehungen häufig in Defekten, die eine komplexe Rekonstruktion erfordern. Um die funktionellen und ästhetischen Einschränkungen so gering wie möglich zu halten, ist eine gute präoperative Planung erforderlich. Dieser Beitrag soll die verschiedenen Möglichkeiten der Rekonstruktion erläutern und diese anhand von Beispielen anschaulich machen.

Abstract

Cancer surgery in the head and neck region often results in complex defects. The reconstructive ladder was developed to guide treatment decisions. In the head and neck region the most straightforward reconstructive technique is often not the most suitable, because it is comprised of many functional and aesthetic subregions that lie close together. If primary closure, secondary wound healing or negative wound pressure therapy are not an option, skin grafting is the next step. Larger or aesthetically and functionally challenging defects are often reconstructed with flap surgery. It is distinguished between local or regional flaps that are rotated or transposed into the defect and distant flaps. The blood supply of local/regional flaps is either random pattern or axial pattern, distant flaps are pedicled or free flaps. The vessels of free flaps are connected to the blood supply in the defect by microvascular anastomoses. The radial forearm flap, the pectoralis major flap and the anterolateral thigh flap are the most common distant flaps in the head and neck region. Preoperative planning is the most important step in reconstructive surgery. The method of reconstruction must be suited to the functional and aesthetic requirements of the defect but also to the morbidity and compliance of the patient and the surgical expertise of the clinic. Not only immediate postoperative complications such as insufficient anastomosis, infections or hematoma but also later, mostly functional complications such as dysphagia or dyspnea must be taken into consideration when planning the reconstruction of a defect in the head and neck region.

Kernaussagen

• Die rekonstruktive Leiter dient zur Orientierung bei der Planung einer Defektdeckung im Kopf-Hals-Bereich.

• Bei der Defektdeckung müssen funktionelle Aspekte wie Schluck-/Sprechfunktion und Atmung sowie ästhetische Aspekte wie Farbe, Form und Dicke des Transplantats beachtet werden.

• Die Methode der Rekonstruktion muss nicht nur an den Defekt, sondern auch an den Patienten und die operative Expertise angepasst werden.

• Die Kenntnis der anatomischen Grundlagen von Empfänger- und Spenderregion, insbesondere der Blutversorgung von Lappenplastik und zu deckendem Defekt, ist unerlässlich und beeinflusst die Wahl des geeigneten Transplantats.

• Die am häufigsten angewendeten Lappenplastiken im Kopf-Hals-Bereich sind der Pectoralis-major-Lappen, der Radialislappen und der anterolaterale Oberschenkellappen.

Schlüsselwörter

Rekonstruktion - Kopf-Hals-Region - Tumorchirurgie - Radialislappen - anterolateraler Oberschenkellappen - Pectoralis-Major-Lappen

Keywords

Reconstruction - head and neck - cancer surgery - radial forearm flap - ALT - pectoralis major flap

Publication History

Article published online:
02 November 2023

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