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Handchir Mikrochir Plast Chir 2022; 54(04): 339-348
DOI: 10.1055/a-1880-0927
Übersichtsarbeit

Muss es immer das Abdomen sein? – Alternative Lappen zur mikrochirurgischen Brustrekonstruktion

Does it Always have to be the Abdomen? Alternative Flaps in Autologous Breast Reconstruction
Rebekka Götzl 
1   Department of Plastic Surgery, Hand Surgery – Burn Center, University Hospital RWTH Aachen, Aachen, Germany
,
Anja M. Boos
1   Department of Plastic Surgery, Hand Surgery – Burn Center, University Hospital RWTH Aachen, Aachen, Germany
,
Justus P. Beier 
1   Department of Plastic Surgery, Hand Surgery – Burn Center, University Hospital RWTH Aachen, Aachen, Germany
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Zusammenfassung

Die DIEP- (Deep inferior epigastric Perforator) oder muskelsparende transverse Rectus-abdominis-Myokutan-Lappenplastik (ms-TRAM) gilt als Gold-Standard in der autologen Brustrekonstruktion bei post-Mastektomie Patientinnen. Einige Patientinnen sind aus verschiedenen Gründen keine geeigneten Kandidatinnen für eine Gewebeentnahme am Bauch. In diesen Fällen stehen diverse andere Hebestellen am Oberschenkel (transverse und diagonale myokutane musculus gracilis Lappenplastik, profunda artery perforator Lappenplastik, lateral thigh perforator Lappenplastik), am Stamm (Lumbalarterienperforator-Lappenplastik) und aus der Gesäßregion (superiore und inferiore Glutealarterien und fasziokutane infragluteale Lappenplastik) zu Verfügung. Dieser Artikel gibt einige Einblicke in die Historie, die relevante Anatomie, die chirurgische Technik und neue Anwendungen wie die Neurotisation alternativer Lappenplastiken zur autologen Brustrekonstruktion.

Abstract

[English] Deep inferior epigastric artery perforator (DIEP) or muscle-sparing transverse rectus abdominis muscle (ms-TRAM) flaps remain the gold standard for autologous reconstruction in post-mastectomy patients, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options based from the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap), trunk (lumbar artery perforator flap), and buttock (superior and inferior gluteal artery perforator flaps). This article will provide insight into the history, relevant anatomy, surgical technique and novel applications (neurotization) for alternative flaps in autologous breast reconstruction.

Schlüsselwörter

Mikrochirurgie - autologe Brustrekonstruktion - TMG-Lappen - PAP-Lappen - LAP-Lappen - S-GAP-Lappen - I-GAP-Lappen - FCI-Lappen - LTP-Lappen

Key words

microsurgery - autologous breast reconstruction - TMG flap - PAP flap - LAP flap - S-GAP flap - I-GAP flap - FCI flap - LTP flap


Publication History

Received: 29 December 2021

Accepted: 16 May 2022

Article published online:
09 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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