Funktionelle Weichgaumen­rekonstruktion mit Radialislappen

Zusammenfassung

Oropharynxkarzinome im Bereich des Weichgaumens stellen eine besondere therapeutische Herausforderung dar. Dies liegt an der Funktion des Weichgaumens für Artikulation und Schluckvorgang. Bei der Beratung der Patienten muss das breite Spektrum der Behandlungsmöglichkeiten erwähnt werden, um zu einer mündigen Entscheidungsfindung zu kommen. Grundsätzlich sollten bei der primär kurativen Behandlung multimodale Therapiekonzepte erwogen werden, deren wesentliche Bestandteile chirurgische Resektion und Radiochemotherapie darstellen. Im Hinblick auf die gelegentlich schwierige Vorhersage des funktionellen Ergebnisses nach Primärtherapie, sollte auch ein Stufenplan plastischer Rekonstruktionsmöglichkeiten a priori miterwogen werden. Bei einer Vielzahl lokaler und gestielter Lappenplastiken gehört der freie mikrovaskuläre Radialislappen zum unverzichtbaren chirurgischen Repertoire. Dieser ermöglicht in nahezu idealer Weise eine funktionelle Rehabilitation nach ausgedehnteren Resektionen. Das impliziert einige zusätzliche Aspekte bei der prä- und postoperativen Patientenbetreuung, die in dieser Übersichtsarbeit dargestellt werden.

Abstract

Oropharyngeal cancer of the soft palate is a therapeutic challenge. This is due to crucial importance of velopharyngeal competence for articulation and swallowing. Patient counseling must present the whole therapeutic spectrum in order to receive informed consent. Basically, in primary therapy of oropharyngeal cancer multimodal concepts have to be considered including surgical resection and radiochemotherapy. With regard to the occasional difficulties predicting the functional outcome after primary therapy the ladder of reconstructive options has to be discussed a priori. Among numerous pedicled flaps the radial forearm free flap nowadays belongs definitely in the surgical armoury, which offers almost ideal reconstructive possibilities after extensive resections. This implies some additional aspects in pre- and postoperative workup that are reviewed in this article.

Schlüsselwörter

Oropharynxkarzinom - Weichgaumeninsuffizienz - Radialislappen - fasziokutanter Lappen - Halsgefäßanastomose

Key words

oropharyngeal cancer - velopharyngeal incompetence - radial forearm flap - fasciocutaneous free flap - cervical vessel anastomosis

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