Der Einsatz der Vakuumtherapie bei der Defektdeckung an der oberen Extremität mit freien mikrochirurgischen arterialisierten venösen Lappen

Zusammenfassung

Arterialisierte venöse Weichteillappenplastiken sind als Lappen definiert, welche über einem rein venösen Stromgebiet - meist am palmarseitigen, distalen Drittel des Unterarmes - gehoben und transplantiert werden. Diese Lappen setzen sich aus Haut, subkutanem Gewebe sowie dem subdermalen venösen Plexus zusammen. Im Empfängerbett wird eine der Lappenvenen an eine ernährende Arterie angeschlossen, während die anderen Gefäße des Plexus an eine oder mehrere drainierende Venen anastomosiert werden. Die retrograde Perfusion führt initial häufig zu Ödemen, Epidermolysen oder gar Hautnekrosen, welche in der weiteren Behandlung jedoch wieder rückläufig sind. Um diese Probleme zu umgehen, wurde die klinische Anwendung dieser Technik mit den bekannten Vorteilen der Vakuumversiegelung kombiniert, um die Einheilung und das Überleben dieser Lappenplastiken in der kritischen Phase der venösen Stromumkehr zu verbessern.

Abstract

Arterialized venous soft tissue flaps are defined as tissue portions usually harvested from the anterior and distal third of the forearm over a venous pathway to be transplanted to another recipient area. Basically, they are composed of skin, subcutaneous tissue, and subdermal venous plexus. At the recipient site flaps are perfused by a nourishing artery while the other veins are connected to one or more regional veins. The retrograde blood perfusion often results in edema, temporary epidermolysis, or even some degree of skin necrosis that disappear during subsequent treatment. To circumvent these drawbacks grafting of arterialized flaps was combined with local application of vacuum to overcome the venous initial stasis, resulting in improved healing and survival of these flaps.

Schlüsselworter

Vakuumtherapie - freier Gewebetransfer - venöse Lappen

Key words

Vacuum therapy - free tissue transfer - venous flap

Literatur

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