Ausgedehnte Gewebedefekte bei vaskulären Wunden – Möglichkeiten der plastischen Chirurgie

Zusammenfassung

Einleitung: Hautweichteildefekte an der minder-perfundierten unteren Extremität stellen eine Herausforderung dar. Ohne adäquate chirurgische Therapie ist in vielen Fällen eine Majoramputation die unausweichliche Konsequenz. Ziel der Therapie ist der Extremitätenerhalt durch Revaskularisation und Defektdeckung.

Methode: Die vorliegende Arbeit soll eine strukturierte Übersicht über aktuelle Therapiestrategien und den differenzierten Einsatz verschiedener Lappenplastiken in Verbindung mit Gefäßbypässen bei der Behandlung von chronischen „vaskulären“ Wunden geben.

Ergebnisse: Zur Defektrekonstruktion kommen neben Techniken der Wundkonditionierung und Spalthauttransplantation gefäßgestielte und mikrochirurgische freie Lappenplastiken gegebenenfalls in Verbindung mit Gefäßbypässen zum Einsatz. Diese Eingriffe erfordern eine interdisziplinäre Vorgehensweise unter Einbeziehung von Gefäßchirurgen und Plastischen Chirurgen.

Diskussion: Derartige komplexe rekonstruktive Maßnahmen sollten nur in Zentren mit entsprechender gefäßchirurgischer und mikrochirurgischer Erfahrung durchgeführt werden.

Abstract

Introduction: Skin and soft-tissue defects at the ischaemic lower extremity represent a challenging condition. Major amputations can be prevented by optimised surgical therapy. The aim of any intervention is the revascularisation and defect reconstruction of the extremity.

Methods: This article aims to provide a structured overview on up-to-date therapeutic strategies and differentiated indications for certain surgical flaps in combination with bypass surgery for the treatment of chronic “vascular” wounds.

Results: Optimised conservative wound therapy, skin grafts, pedicled or microsurgical free flaps in combination with vascular bypasses can be applied to salvage ischaemic extremities. These operations require an interdisciplinary cooperation between vascular surgeons and plastic surgeons.

Discussion: These procedures should accordingly only be performed in specialised high-volume centres with significant vascular surgical and microsurgical expertise.

Schlüsselwörter

Bypasschirurgie - diabetische Angiopathie - distale Bypasschirurgie - freier mikrochirurgischer Gewebetransfer - plastische Chirurgie

Key words

bypass surgery - diabetic angiopathy - distal bypass surgery - free microsurgical tissue transfer - plastic surgery

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