Einsatz der Vakuumtherapie bei einer großflächigen arterialisierten venösen Lappenplastik zur Rekonstruktion einer kompletten Daumenavulsionsverletzung

Zusammenfassung

Arterialisierte venöse Lappenplastiken werden in der Regel über dem palmarseitigen, distalen Drittel des Unterarmes über einem venösen Abstromgebiet gehoben und setzen sich aus Haut, subkutanem Gewebe sowie dem subdermalen venösen Plexus zusammen. Nach Transposition des Gewebes in das Empfängerbett wird eine der Lappenvenen an eine zuführende Arterie angeschlossen, während die anderen Gefäße des Plexus an eine oder mehrere dränierende Venen anastomosiert werden. Die atypische Perfusion sowie die verzögerte Öffnung intervenöser Shunts führen häufig zu Ödemen, Epidermolysen oder gar Hautnekrosen welche in der weiteren Behandlung jedoch wieder rückläufig sind. Wir berichten über die Therapie eines atypisch gehobenen, überdimensionierten arterialisierten venösen Lappens zur Rekonstruktion einer kompletten Daumenavulsion, bei der durch Applikation der Vakuumtherapie die vorangehend beschriebenen Probleme der atypischen Perfusion und verzögerten Shuntöffnung umgangen und das stabile Einheilen der Lappenplastik gewährleistet werden konnten.

Abstract

Arterialized venous flaps are normally raised from the anterior and distal third of the forearm by integration of a venous pathway. Basically, they are composed of skin, subcutaneous tissue, and subdermal venous plexus. Following transposition to the recipient site one vein is linked to a nourishing artery while the other veins are connected to one or more regional veins. The atypical blood perfusion and the delayed opening of intervenous shunts may result in edema, epidermolysis, or even some degree of skin necrosis that disappear during subsequent treatment. We report the salvage of an atypically raised oversized arterialized venous flap for total soft tissue reconstruction in a complete avulsion of a thumb. By applying V.A.C.® therapy atypical perfusion and early intervenous shunt formation was treated successfully, resulting in stable healing and survival of the flap.

Vakuumtherapie - freier Gewebetransfer - venöse Lappen

vacuum therapy - free tissue transfer - venous flap

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