Der sichere Lappen – Präoperatives Gefäß-Mapping und intraoperative Perfusionsmessung zur Reduktion der lappenbedingten Morbidität

D. Schmauss; J.P. Beier; S.U. Eisenhardt; R.E. Horch; A. Momeni; M. Rab; B. Rieck; U. Rieger; D.J. Schaefer; V.J. Schmidt; U. Kneser

doi:10.1055/a-0987-0118

Handchirurgie · Mikrochirurgie · Plastische Chirurgie, Table of Contents

Handchir Mikrochir Plast Chir 2019; 51(06): 410-417
DOI: 10.1055/a-0987-0118

Consensus Statement

Der sichere Lappen – Präoperatives Gefäß-Mapping und intraoperative Perfusionsmessung zur Reduktion der lappenbedingten Morbidität

Konsensuspapier der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und GefäßeThe „safe“ flap – Preoperative perforator-mapping and intraoperative perfusion assessment to reduce flap-associated morbidityConsensus statement of the German Speaking Working Group for Microsurgery of the Peripheral Nerves and Vessels

Authors

D. Schmauss

¹Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Schweiz

²Klinik für Plastische Chirurgie und Handchirurgie, Klinikum Rechts der Isar, Technische Universität München
J.P. Beier

³Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinik RWTH Aachen
S.U. Eisenhardt

⁴Klinik für Plastische und Handchirurgie, Medizinische Fakultät, Universitätsklinikum Freiburg
R.E. Horch

⁵Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Friedrich Alexander Universität Erlangen-Nürnberg FAU
A. Momeni

⁶Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA, USA
M. Rab

⁷Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Klinikum Klagenfurt, Österreich
B. Rieck

⁸Klinik für Plastische, Ästhetische und Handchirurgie, Helios Klinikum Hildesheim
U. Rieger

⁹Klinik für Plastische und Ästhetische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus Krankenhaus Frankfurt
D.J. Schaefer

¹⁰Klinik für Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel, Schweiz
V.J. Schmidt

¹¹Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Hand- und Plastische Chirurgie der Universität Heidelberg
U. Kneser

¹¹Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Hand- und Plastische Chirurgie der Universität Heidelberg

Abstract

Zusammenfassung

Die rekonstruktive Mikrochirurgie mittels freier und gefäßgestielter Lappenplastiken ist heutzutage ein zuverlässiges Standardverfahren mit hohen Erfolgsraten. Um die Lappen-bedingte Morbidität noch weiter zu senken und die Eingriffe noch sicherer und vorhersehbarer zu gestalten, gewinnt das präoperative Gefäß-Mapping und die intraoperative Perfusionsmessung immer mehr an Bedeutung. Sowohl für das Gefäß-Mapping, als auch die Perfusionsmessung stehen verschiedene Methoden zur Verfügung, für deren Verwendung es jedoch keine Empfehlung gibt. In einem Konsensus-Workshop der 40. Jahrestagung der deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM) wurde die Datenlage in einer Expertenrunde kritisch geprüft und ein Konsensus erarbeitet. Dieser stellt zum einen das Meinungsbild der Expertenrunde dar und gibt zum anderen vor dem Hintergrund der aktuellen Literatur Empfehlungen zur Verwendung des präoperativen Gefäß-Mappings und der intraoperativen Perfusionsmessung.

Abstract

Reconstructive microsurgery using free and pedicled flaps has become a reliable method with a high success rate. Preoperative perforator mapping and intraoperative assessment of perfusion might further reduce flap-associated morbidity.

There are various techniques for perforator mapping and perfusion measurement, but no guidelines regarding their use. Therefore, an expert panel at the 40th Annual Meeting of the German-Speaking Working Group for Microsurgery of the Peripheral Nerves and Vessels (DAM) discussed and critically reviewed the current literature. The consensus statement represents the expert opinion based on the available literature and provides recommendations regarding the use of preoperative perforator mapping and intraoperative perfusion measurement.

Schlüsselwörter

Mikrochirurgie - freie Lappenplastiken - gestielte Lappenplastiken - Perforans-Lappenplastiken - bildgebende Verfahren

Key words

Microsurgery - free flap grafts - pedicled flap grafts - perforator flap grafts - imaging procedures

Full Text

References

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