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OP-Journal 2013; 29(2): 175-182
DOI: 10.1055/s-0033-1351004
Georg Thieme Verlag KG Stuttgart · New York

Mikrochirurgisch revaskularisiertes Beckenkammtransplantat für Rekonstruktionen von Unter- und Oberkiefer: Varianten zur Senkung der Entnahmemorbidität

Microsurgically Revascularised Iliac Crest Transplants for Mandibular and Maxillary Reconstruction – Modifications to Reduce Donor Site Morbidity
Bernhard Frerich
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Publication History

Publication Date:
20 January 2014 (online)

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Zusammenfassung

Der Transfer des mikrochirurgisch revaskularisierten Beckenkammtransplantats („deep circumflex iliac artery -flap“, DCIA) ist nach wie vor eine wertvolle Methode für die Unter- und Oberkieferrekonstruktion. Seine Vorteile liegen in dem – verglichen mit anderen mikrovaskulären Transplantaten – konkurrenzlosen Knochenangebot. Allerdings ist es mit dem Ruf einer hohen Entnahmemorbidität belastet. Seit Längerem sind Weiterentwicklungen der Entnahmetechnik beschrieben worden, welche die Entnahmemorbidität deutlich vermindern können, ohne die Vorteile des Transplantats zu verlieren. Dazu gehören der Erhalt der Spina iliaca anterior superior und der äußeren Kortikalisschicht durch monokortikale Entnahme von der Beckeninnenfläche, sowie die Schonung der sensiblen Nerven in der Entnahmeregion, insbesondere des N. cutaneus femoris lateralis. Weitere wichtige Gesichtspunkte liegen im Umfang eines zugleich gehobenen Weichgewebsanteils (M.-obliquus-internus-Schürze oder kutaner Lappen im Sinne eines Composite Lappen), sowie in der Technik des Entnahmedefektverschlusses. Zwar ist die Hebung des mikrovaskulär gestielten Beckenkammtransplantats vergleichsweise aufwendig, jedoch lohnend, da es sich um ein sehr vielseitig einsetzbares Transplantat handelt.

Abstract

The microsurgically revascularised deep circumflex iliac artery (DCIA) flap still is a useful method in reconstruction of the mandible and the maxilla. In comparison to osseous transplants from other donor regions, the unrivalled abundancy of bone mass is a particular advantage. A well-known disadvantage, however, remains the donor site morbidity. Advancements in harvesting techniques have resulted in lower donor morbidity, without loss of the advantages of the DCIA flap. These techniques include preservation of the superior anterior iliac spine and the outer table of the iliac crest. A meticulous and sparing soft tissue handling will contribute to reduced donor site morbidity as well as the preservation of regional sensory nerves, in particular of the lateral femoral cutaneous nerve. The harvest of the DCIA flap is relatively elaborate compared to other bone-containing flaps, but nevertheless worthwhile, since it provides a most versatile transplant which is applicable to challenging scenarios in mandibular or maxillary reconstruction.

 

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