Plastische Deckung ausgedehnter Defekte nach exenterativen Eingriffen im Becken

Zusammenfassung

Die erweiterte Resektion von malignen Erkrankungen des kleinen Beckens führt zu großen Weichteildefekten im Bereich des Perineums. Dies ist der Fall bei Prozeduren wie z. B. ausgedehnter extralevatorischer Rektumexstirpation und Beckenexenteration. Aus solchen Eingriffen resultieren große sakrale/perineale Wunden, die in aller Regel schwer zu versorgen sind. Ein primärer Verschluss im kleinen Becken ist, aufgrund der häufig vorangegangenen Radiatio und der fehlenden Gewebesubstanz nach Resektion (insbesondere Muskelgewebe), oft nicht oder nur unter nicht akzeptabler Spannung durchzuführen. Die Folge können schlecht oder nicht heilende Wunden sein mit hohem Pflegeaufwand und erhöhtem Risiko für sekundäre Probleme einschließlich Tumorrezidiven. Ein dauerhafter Verschluss von guter Qualität kann daher nur durch Mobilisation von Muskelgewebe erfolgen. Dies kann durch das Rotieren oder Verschieben von Muskellappen mit oder ohne Hautinsel erfolgen wie dem M.-glutaeus-maximus-Lappen, dem vertikalen M.-rectus-abdominis-Lappen (VRAM) oder freien Lappen wie dem M.-latissimus-dorsi-Lappen.

Abstract

Extended resections of pelvic malignancies, especially in cases of recurrent malignancies, result in the formation of large tissue defects in the region of the pelvic floor and perineum, which are difficult to deal with. Both after extra levator rectal excision and pelvic exenteration, wound healing deficiencies and local infections of the perineal wound are frequent. Primary closure is often impossible due to a lack of tissue substance after resection and an additional previous radiotherapy in most cases. This can result in poor or non-healing wounds, a consecutive need of complex care and an increased risk of secondary problems including tumour recurrences. A permanent wound closure of good quality can therefore only be achieved by plastic surgery. This can be done by local or distant muscle flaps with or without skin, for example, the gluteus maximus flap, the vertical rectus abdominis muscle flap (VRAM) or free flaps such as the latissimus dorsi flap.

Schlüsselwörter

Beckenexenteration - Wundinfekt - Lappenplastik - Wundheilungsstörung

Key words

pelvic exenteration - wound infection - plastic reconstruction - wound healing disorder

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