Therapieoptionen zur Rekonstruktionen der dorsalen Rumpfwand

Zusammenfassung

Defekte der dorsalen Rumpfwand stellen herausfordernde rekonstruktive Probleme dar, welche aufgrund der speziellen Anatomie die Beherrschung verschiedener Techniken erfordern. In Abhängigkeit von der Lokalisation können Defektdeckungen an der dorsalen Rumpfwand mit einfachen Verschiebeschwenklappenplastiken, Propellerlappenplastiken, gestielten Lappenplastiken und freien Lappenplastiken durchgeführt werden. Die Mehrzahl der Defekte kann mit gestielten Verfahren verschlossen werden. Besteht die Indikation zur Defektdeckung mittels freier Lappenplastik, kann ein Gefäßinterponat den Anschluss erleichtern.

Mit Ausnahme der M. latissimus dorsi-Umkehrlappenplastik konnte im eigenen Patientengut mit sämtlichen Verfahren ein suffizienter Defektverschluss erreicht werden. Basierend auf der anatomischen Lokalisation stellen wir anhand unserer Erfahrungen einen Therapiealgorithmus zur Defektdeckung am der dorsalen Rumpfwand auf.

Abstract

Posterior trunk defects represent a major reconstructive problem, which require the entire armamentarium of the reconstructive surgeon. Given the special anatomy of the back, flap selection includes transposition flaps, perforator flaps, muscle flaps, turn-over flaps and free flaps, eventually with interposition of vein grafts. The majority of the defects can be closed with pedicled muscle or musculocutaneous flaps. In our patient collective, sufficient closure could be obtained with all procedures, except the latissimus dorsi turn-over flap. Based on our clinical experience, we propose an algorithm for closure of posterior trunk defects related to the anatomical region.

Schlüsselwörter

Rücken - freie Lappenplastiken - gestielte Lappenplastiken - Perforans- Lappenplastiken - Rekonstruktion

Key words

posterior trunk - free flaps - pedicled flaps - perforator flaps - reconstruction

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