Postoperatives Monitoring freier Muskellappenplastiken mittels perforatorbasierten adipokutanen Monitorinseln: Ökonomie, Versorgungsqualität und Ästhetik

Zusammenfassung

Hintergrund Freie Muskellappenplastiken zur Rekonstruktion großer Weichteildefekte sind neben fasziokutanen Lappenplastiken etablierte mikrochirurgische Standardverfahren. Diese werden häufig mit adipokutanen Monitorinseln zur Durchblutungskontrolle geplant. In unserer Klinik werden sowohl konventionelle, breitbasig aufsitzende adipokutane Monitorinseln (random pattern), als auch perforatorbasierte Monitorinseln verwendet. Während konventionelle Monitorinseln in einer zweiten Operation abgetragen werden müssen und der verbliebene Defekt mit Spalthauttransplantaten versorgt werden muss, können perforatorbasierte Monitorinseln am Patientenbett mittels einfacher Ligatur entfernt werden. In der vorliegenden Studie sollen ökonomische, versorgungsqualitative und ästhetische Aspekte perforatorbasierter versus herkömmlicher adipokutaner Monitorinseln nach freiem Muskellappentransfer verglichen werden.

Patienten und Methoden Im Zeitraum von August 2014 bis Juli 2016 konnten anhand einer retrospektiven Datenanalyse 102 geeignete Patienten identifiziert werden. Patienten mit perforatorbasierter Monitorinsel (Gruppe A) wurden einem Kollektiv von Patienten mit breitbasig aufsitzender Monitorinsel (Gruppe B) gegenübergestellt. Patientencharakteristika, Operationszeiten, ökonomische Daten und ästhetische Ergebnisse wurden zwischen den Gruppen verglichen.

Ergebnisse Bei 72 Patienten wurden perforatorbasierte (Gruppe A, 71 %), bei 30 Patienten konventionelle (Gruppe B, 29 %) Monitorinseln gehoben. Patienten-, Defekt- und Lappencharakteristika waren in beiden Gruppen vergleichbar. Operations- und Säulenzeit waren in Gruppe B tendenziell kürzer, jedoch ohne statistische Signifikanz zu erreichen (p = 0,35; p = 0,28). Die Entfernung der Monitorinsel in Gruppe A erfolgte signifikant früher (p < 0,01). Sowohl die gesamtstationäre als auch die postrekonstruktive Verweildauer waren in Gruppe A signifikant kürzer (p = 0,03; p < 0,01). Personelle und materielle Ressourcen konnten in Gruppe A geschont und ein ästhetisch ansprechenderes Ergebnis erzielt werden.

Schlussfolgerung Mit perforatorbasierten Monitorinseln kann eine zweite Operation zur Monitorinselabtragung und Hauttransplantation vermieden werden. Hierdurch kann eine Reduktion der stationären Verweildauern mit Schonung der materiellen und personellen Ressourcen erreicht werden.

Abstract

Introduction Besides fasciocutaneous workhorse flaps, free muscle flaps for the reconstruction of large soft tissue defects are well-established standard microsurgical procedures. Random-pattern adipocutaneous skin paddles are often included for postoperative perfusion monitoring of the muscle flap. At our institution, both conventional broad-based and perforator-based adipocutaneous skin paddles are used. While conventional skin paddles have to be removed during a second operation, perforator-based skin paddles can be removed at the bedside by ligature. The present study aims to compare economic aspects, quality of care and aesthetic results of perforator-based versus conventional adipocutaneous skin paddles after free muscle flap transfer.

Methods 102 patients treated between August 2014 and July 2016 were identified and included in a retrospective data analysis. Patients with perforator-based skin paddles (group A) were compared with a population of patients with conventional skin paddles (group B). Patient characteristics, procedural characteristics, economic data and aesthetic results were compared between both groups.

Results Perforator-based skin paddles were raised in 72 patients (group A, 71 %), and conventional skin paddles were raised in the remaining 30 patients (group B, 29 %). Patient, defect, and flap characteristics were comparable in both groups. Operating times tended to be shorter in group B. Skin paddle removal was performed significantly earlier in group A (p < 0.01). Both overall and post-reconstructive length of hospital stay were significantly shorter in group A (p = 0.03; p < 0.01). Also, personnel and material resources were saved and more satisfactory aesthetic results were achieved in group A.

Conclusion Perforator-based monitor islands can help avoid secondary operations that would otherwise be necessary to remove monitoring skin paddles. Thus, the inpatient length of stay can be reduced while sparing material and human resources.

Schlüsselwörter

Freie Muskellappenplastik - Monitorinsel - Hautinsel - mikrochirurgisches Lappenmonitoring - Lappenperfusion

Key words

Free muscle flap - skin paddle - free flap monitoring - flap perfusion

Publikationsverlauf

Eingereicht: 16. März 2021

Angenommen: 20. September 2021

Artikel online veröffentlicht:
14. März 2022

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