Handchir Mikrochir Plast Chir 2014; 46(02): 90-96
DOI: 10.1055/s-0034-1370994
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Therapieoptionen zur Rekonstruktionen der dorsalen Rumpfwand

Therapeutic Options for Reconstruction of the Dorsal Trunk Wall
B. Behr
1   Klinik für Plastische Chirurgie, Universitätsklinikum Bergmannsheil Bochum, Bochum
,
T. Hirsch
1   Klinik für Plastische Chirurgie, Universitätsklinikum Bergmannsheil Bochum, Bochum
,
O. Goertz
1   Klinik für Plastische Chirurgie, Universitätsklinikum Bergmannsheil Bochum, Bochum
,
A. Ring
1   Klinik für Plastische Chirurgie, Universitätsklinikum Bergmannsheil Bochum, Bochum
,
M. Lehnhardt
1   Klinik für Plastische Chirurgie, Universitätsklinikum Bergmannsheil Bochum, Bochum
,
A. Daigeler
1   Klinik für Plastische Chirurgie, Universitätsklinikum Bergmannsheil Bochum, Bochum
› Author Affiliations
Further Information

Publication History

eingereicht 20 February 2014

akzeptiert 24 February 2014

Publication Date:
28 April 2014 (online)

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.

 
  • Literatur

  • 1 Hallock GG. Reconstruction of posterior trunk defects. Seminars in plastic surgery 2011; 25: 78-85
  • 2 Mathes DW, Thornton JF, Rohrich RJ. Management of posterior trunk defects. Plastic and reconstructive surgery 2006; 118: 73e-83e
  • 3 Kroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects. Plastic and reconstructive surgery 1988; 81: 561-566
  • 4 Hamdi M, Stillaert FB. Pedicled perforator flaps in the trunk. Clin Plast Surg 2010; 37: 655-665 vii
  • 5 Koshima I, Moriguchi T, Soeda S et al. The gluteal perforator-based flap for repair of sacral pressure sores. Plastic and reconstructive surgery 1993; 91: 678-683
  • 6 Roche NA, Van Landuyt K, Blondeel PN et al. The use of pedicled perforator flaps for reconstruction of lumbosacral defects. Annals of plastic surgery 2000; 45: 7-14
  • 7 Stevenson TR, Rohrich RJ, Pollock RA et al. More experience with the “”reverse” latissimus dorsi musculocutaneous flap: precise location of blood supply. Plastic and reconstructive surgery 1984; 74: 237-243
  • 8 Bostwick 3rd J, Scheflan M, Nahai F et al. The “reverse” latissimus dorsi muscle and musculocutaneous flap: anatomical and clinical considerations. Plastic and reconstructive surgery 1980; 65: 395-399
  • 9 Hallock GG. An extended latissimus dorsi “non-free” flap. Br J Plast Surg 1987; 40: 516-517
  • 10 Pallua N, Magnus Noah E. The tunneled supraclavicular island flap: an optimized technique for head and neck reconstruction. Plastic and reconstructive surgery 2000; 105: 842-851 discussion 852-844
  • 11 Su T, Pirgousis P, Fernandes R. Versatility of supraclavicular artery island flap in head and neck reconstruction of vessel-depleted and difficult necks. J Oral Maxillofac Surg 2013; 71: 622-627
  • 12 Mathes SJ, Stevenson TR. Reconstruction of posterior neck and skull with vertical trapezius musculocutaneous flap. Am J Surg 1988; 156: 248-251
  • 13 Lynch JR, Hansen JE, Chaffoo R et al. The lower trapezius musculocutaneous flap revisited: versatile coverage for complicated wounds to the posterior cervical and occipital regions based on the deep branch of the transverse cervical artery. Plastic and reconstructive surgery 2002; 109: 444-450
  • 14 Disa JJ, Smith AW, Bilsky MH. Management of radiated reoperative wounds of the cervicothoracic spine: the role of the trapezius turnover flap. Annals of plastic surgery 2001; 47: 394-397
  • 15 Ramasastry SS, Schlechter B, Cohen M. Reconstruction of posterior trunk defects. Clin Plast Surg 1995; 22: 167-185
  • 16 Wilhelmi BJ, Snyder N, Colquhoun T et al. Bipedicle paraspinous muscle flaps for spinal wound closure: an anatomic and clinical study. Plastic and reconstructive surgery 2000; 106: 1305-1311
  • 17 Daigeler A, Simidjiiska-Belyaeva M, Drucke D et al. The versatility of the pedicled vertical rectus abdominis myocutaneous flap in oncologic patients. Langenbeck’s archives of surgery/Deutsche Gesellschaft für Chirurgie 2011; 396: 1271-1279
  • 18 Koh PK, Tan BK, Hong SW et al. The gluteus maximus muscle flap for reconstruction of sacral chordoma defects. Annals of plastic surgery 2004; 53: 44-49
  • 19 Park S, Koh KS. Superior gluteal vessel as recipient for free flap reconstruction of lumbosacral defect. Plastic and reconstructive surgery 1998; 101: 1842-1849
  • 20 Few JW, Marcus JR, Lee MJ et al. Treatment of hostile midline back wounds: an extreme approach. Plastic and reconstructive surgery 2000; 105: 2448-2451
  • 21 Earle AS, Feng LJ, Jordan RB. Long saphenous vein grafts as an aid to microsurgical reconstruction of the trunk. Journal of reconstructive microsurgery 1990; 6: 165-169
  • 22 Chun JK, Lynch MJ, Poultsides GA. Distal trapezius musculocutaneous flap for upper thoracic back wounds associated with spinal instrumentation and radiation. Annals of plastic surgery 2003; 51: 17-22