Stellenwert der V.A.C.®-Therapie beim fortgeschrittenen Kopfhautmalignom

M. V. Schintler; E.-C. Prandl; G. Wittguber; B. Zink; S. Spendel; B. Hellbom; E. Scharnagl

doi:10.1055/s-2004-822690

Zentralblatt für Chirurgie, Table of Contents

Zentralbl Chir 2004; 129: 141-146
DOI: 10.1055/s-2004-822690

Originalarbeit

Stellenwert der V.A.C.®-Therapie beim fortgeschrittenen Kopfhautmalignom

The Impact of the VAC-Treatment for Locally Advanced Malignancy of the ScalpM. V. Schintler¹ , E.-C Prandl¹ , G. Wittguber¹ , B. Zink¹ , S. Spendel¹ , B. Hellbom¹ , E. Scharnagl¹

¹Klinische Abteilung für Plastische Chirurgie, Medizinische Universität Graz, Graz, Austria

Abstract

Zusammenfassung

Lokal fortgeschrittene Kopfhautmalignome erfordern eine aggressive Therapie in Form einer chirurgischen Resektion und Rekonstruktion [47]. Soweit das Periost intakt ist, stellt die Spalthauttransplantation eine simple Methode dar, zumal eine direkte Exzision und Verschluss unter Einhaltung der erforderlichen Radikalität durch Fehlen der entsprechenden Elastizität der Skalphaut kaum möglich ist [11] [36]. Bei fehlendem Periost oder knöchernem Defekt sind lokale oder freie Lappenplastiken [27] [29] [44] die Therapie der Wahl für einen suffizienten Wundverschluss. Ein steigendes geriatrisches und polymorbides Krankengut mit eingeschränkter Wundheilung [4] erfordert eine chirurgische Therapie unter Berücksichtigung des Operationsrisikos bzw. des Für und Widers um eine Allgemeinnarkose [7] [8] [9] [13] [16] [45]. Eine einfache Methode, welche beides berücksichtigt, nämlich eine ausreichende Radikalität unter Einschluss der Tabula externa der Calvaria mit nachfolgender Wundbettkonditionierung und einfacher Hauttransplantation als zweizeitigen Eingriff, als auch eine Minimierung des hohen perioperativen Risikos durch mögliche Durchführung des Eingriffes in Lokalanästhesie und Analgosedierung durch Anwendung des V.A.C.®-Systemes wird präsentiert.

Abstract

Locally advanced cutaneous malignancy of the scalp is a desease that requires an aggressive approach to resection and reconstruction. In cases where the pericranium is intact a split-thickness skin graft is a simple treatment, since direct closure often fails because due to the lack of elasticity of the scalp [11] [36]. If there is a loss of periosteum or a skull defect local or free flaps [27] [29] [44] are necessary for sufficient coverage. Increasing geriatric and polymorbid patients with impaired wound healing [4] require surgical treatment, considering pros and cons for general anaesthesia [7] [8] [9] [13] [16] [45]. A simple method of both, combining radicality of tumorresection with outer table bone and skin grafting as a two stage procedure, while minimizing perioperative risk using local anaesthesia and analgo-sedation, using the vacuum assisted closure device, is presented.

Schlüsselwörter

Lokal fortgeschrittenes Kopfhautmalignom - Skalprekonstruktion - V.A.C.® - Vacuum assisted closure - geriatrischer Patient - Polymorbidität

Key words

Cutaneous malignancy - scalp reconstruction - V.A.C.® - vacuum assisted closure - geriatric patient - polymorbidity

Full Text

References

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