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Praxis der Plastischen Chirurgie pp 223–233Cite as

Rekonstruktion an der unteren Extremität

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Zusammenfassung

Ausgedehnte Knochen- und Weichteildefekte der unteren Extremität können die Folge von Trauma, Tumoren, Dekubiti oder Verbrennungen sein. Nicht selten gehen konzeptionelle Fehler bei der Operationsplanung mit einer erhöhten Komplikationsrate einher. So erfordern nicht nur komplexe Rekonstruktionsverfahren mit mikrovaskulären Lappentransplantaten, sondern auch elektive Eingriffe wie z. B. die Endoprothesenimplantation eine sorgfältige und präoperative Diagnostik des Gefäßstatus der unteren Extremität. Zur Optimierung des Outcome sind zudem eingriffsspezifische Faktoren wie die Festlegung des Operationszeitpunktes und die Auswahl des geeigneten Operationsverfahrens unter Berücksichtigung der rekonstruktiven Leiter essenziell. Dies erfordert ein interdisziplinäres Konzept mit frühestmöglicher Einbindung des Plastischen Chirurgen im Rahmen des Schockraummanagements.

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Literatur

  • Arbeit JM, Hilaris BS, Brennan MF (1987) Wound complications in the multimodality treatment of extremity and superficial truncal sarcomas. J Clin Oncol 5: 480–488

    PubMed  CAS  Google Scholar 

  • Aust M Spies M, Kall S, Gohritz A, Rosenthal H, Pichlmaier M, Oehlert G, Vogt PM (2007) Vascular interventions and reconstructive plastic surgery. Optimizing the treatment of chronic wounds. Chirurg 78 (8): 729–736

    Article  PubMed  CAS  Google Scholar 

  • Barrie KA, Steinmann SP, Shin AY, Spinner RJ, Bishop AT (2004) Gracilis free muscle transfer for restoration of function after complete brachial plexus avulsion. Neurosurg Focus 16 (5): E8

    Article  PubMed  Google Scholar 

  • Barwick WJ, Goldberg JA, Scully SP, Harrelson JM (1992) Vascularized tissue transfer for closure of irradiated wounds after soft tissue sarcoma resection. Ann Surg 216 (5): 591–595

    Article  PubMed  CAS  Google Scholar 

  • Boorboor P, Lahoda LU, Spies M, Kuether G, Waehling K, Vogt PM (2006) Resektion der infizierten Achillessehne. Ergebnisse nach plastischer Defektdeckung ohne Achillessehnenersatz. Chirurg 77: 1144–1151

    Article  PubMed  CAS  Google Scholar 

  • Dellinger EP, Miller SD, Wertz MJ, Grypma M, Droppert B, Anderson PA (1988) Risk of infection after open fracture of the arm or leg. Arch Surg 123: 1320–1327

    Article  PubMed  CAS  Google Scholar 

  • Enzinger FM, Weiss SW (2007) Soft tissue tumors. Elsevier, Oxford

    Google Scholar 

  • Erni D, Banic A, Signer C, Sigurdsson GH (1999) Effects of epidural anaesthesia on microcirculatory blood flow in free flaps in patients under general anaesthesia. Eur J Anaesth 16: 692–698

    CAS  Google Scholar 

  • Evans GR, Black JJ, Robb GL, Baldwin BJ, Kroll SS, Miller MJ, Reece GP, Schusterman MA (1997) Adjuvant therapy: the effects on microvascular lower extremity reconstruction. Ann Plast Surg 39: 141–144

    Article  PubMed  CAS  Google Scholar 

  • Germann G, Steinau HU (1993) Die Indikation für Veneninterponate bei der mikrochirurgischen Rekonstruktion komplexer Defekte der unteren Extremität nach Tumor und Trauma. Unfallchirurgie 6: 358–363

    Article  Google Scholar 

  • Godina M (1986) Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 78: 185–192

    Google Scholar 

  • Gustilo RB, Anderson JB (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. J Bone Joint Surg 58: 453–458

    PubMed  CAS  Google Scholar 

  • Gustilo RB, Merkow RL, Templeman D (1990) The management of open fractures. J Bone Joint Surg Am 72: 299–304

    PubMed  CAS  Google Scholar 

  • Haas F, Seibert FJ, Koch H et al. (2003) Reconstruction of combined defects of the Achilles tendon and the overlying soft tissue with a fascia lata graft and a free fasciocutaneous lateral arm flap. Ann Plast Surg 51: 376–382

    Article  PubMed  Google Scholar 

  • Heinz TR (1997) Local flaps for hindfoot reconstruction. Operative techniques in Plastic and Reconstructive Surgery. 4 (4): 157–164

    Article  Google Scholar 

  • Howard PW, Makin GS (1990) Lower limb fractures with associated vascular injury. J Bone Joint Surg Br, 72 (1): 116–120

    PubMed  CAS  Google Scholar 

  • Kuo YR, Kuo MH, Chou WC et al. (2003) One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: clinical experience and functional assessment. Ann Plast Surg 50: 149–155

    Article  PubMed  Google Scholar 

  • Lange RH, Bach AW, Hansen ST Jr, Johansen KH (1985) Open tibial fractures with associated vascular injuries for limb salvage. J Trauma 25 (3): 203– 208

    Article  PubMed  CAS  Google Scholar 

  • Lehnhardt M, Kuhnen C, Drucke D, Homann HH, Joneidi Jafari H, Steinau HU (2004) Liposarcoma of the extremities: recent developments in surgical therapy--analysis of 167 patients. Chirurg 75 (12): 1182–1190

    Article  PubMed  CAS  Google Scholar 

  • Levin LS (1993) The reconstructive ladder. An orthoplastic approach. Orthop Clin 24: 393–409

    CAS  Google Scholar 

  • Maisels DO (1961) Repairs of the heel. Br J Plast Surg 14: 117

    Article  PubMed  CAS  Google Scholar 

  • Martin RL, Manning CM, Carcia CR, Conti SF (2005) An outcome study of chronic Achilles tendinosis after excision of the Achilles tendon and flexor hallucis longus tendon transfer. Foot Ankle Int 26: 691–697

    PubMed  Google Scholar 

  • McCraw JB, Furlow LT (1975) The dorsalis pedis arterialized flap: a clinical study. Plast Reconstr Surg 55 (2): 177–185

    Article  PubMed  CAS  Google Scholar 

  • Merimsky O, Kollender Y, Inbar M, Lev-Chelouche D, Gutman M, Issakov J, Mazeh D, Shabat S, Bickels J, Meller I (2001) Is forequarter amputation justified for paliation of intractable cancer symptoms? Oncology 60 (1): 55–59

    Article  PubMed  CAS  Google Scholar 

  • Paz IB, Wagman LD, Terz JJ, Chandrasekhar B, Lorant JA, Moscarello GM, Odom-Maryon T (1992) Extended indications for functional limb-sparing surgery in extremity sarcoma using complex reconstruction. Arch Surg 127: 1278–1281

    Article  PubMed  CAS  Google Scholar 

  • Sadrian R, Niederbichler AD, Friedman J, Vogt PM, Steinau HU, Reece G, Chang D, Robb G, Evans GR (2002) Intraarterial chemotherapy: the effects on free-tissue transfer. Plast Reconstr Surg 109: 1254–1258

    Article  PubMed  Google Scholar 

  • Steiert AE, Gohritz A, Schreiber TC, Krettek C, Vogt PM (2008) Delayed flap coverage of open extremity fractures after previous vacuum-assisted closure (VAC) therapy – worse or worth? J Plastic Reconstr Surg xx: 1–9

    Google Scholar 

  • Steinau HU, Biemer E (1985) Possibilities of plastic surgical reconstruction in limb-sparing resection of malignant soft tissue tumors of the extremities. Chirurg 56: 741–745

    PubMed  CAS  Google Scholar 

  • Steinau HU, Feller AM, Hörl HW, Kunisch M, Klein B, Biemer E (1989) Zur Problematik posttraumatischer Fersenweichteildefekte. Chirurg 60: 287– 294

    PubMed  CAS  Google Scholar 

  • Steinau HU, Homann HH, Drucke D, Torres A, Soimaru D, Vogt P (2001) Resection method and functional restoration in soft tissue sarcomas of the extremities. Chirurg 72 (5): 501–513

    Article  PubMed  CAS  Google Scholar 

  • Taylor AC, Tempest MN (1988) Arteries of the skin. Springer, Berlin Heidelberg New York

    Google Scholar 

  • Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body. Experimental study and clinical applications. Br J Plast Surg 40: 113–141

    Article  PubMed  CAS  Google Scholar 

  • Terzis JK, Noah ME (1997) Analysis of 100 cases of free-muscle transplantation for facial paralysis. Plast Reconstr Surg 99 (7): 1905–1921

    Article  PubMed  CAS  Google Scholar 

  • Tscherne H, Gotzen L (1984) Fractures with soft-tissue injuries, Springer, Berlin Heidelberg New York

    Google Scholar 

  • Tschopp H, Banic A (1992) Perfusionsprobleme bei der Defektversorgung im Fuß-Knöchelbereich. 22. Jahrestagung der Vereinigung der Deutschen Plastischen Chirurgen, Erlangen, 24.–26.09.1992

    Google Scholar 

  • Vogt PM, Steinau HU, Druecke D (2006) Maligne Weichgewebstumoren des Stammes und der Extremitäten, Pichlmayrs Chirurgische Therapie. Springer, Berlin Heidelberg New York, S 169 ff.

    Google Scholar 

  • Vogt PM, Steinau HU, Spies M, Kall S, Steiert A, Boorboor P, Vaske B, Jokuszies A (2007) Outcome of simultaneous and staged microvascular free tissue transfer connected to arteriovenous loops in areas lacking recipient vessels. Plast Reconstr Surg 120 (6): 1568–1575

    Article  PubMed  CAS  Google Scholar 

  • Williard WC, Collin C, Casper ES, Hajdu SI, Brennan MF (1992) The changing role of amputation for soft tissue sarcoma of the extremity in adults. Surg Gynecol Obstet 175: 389–396

    PubMed  CAS  Google Scholar 

  • Windhager R, Milesi H, Kotz R (1995) Resection-replantation for primary malignant tumors of the arm. An alternative to fore-quarter amputation. J Bone Joint Surg Br 77: 176–184

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover

    Dr. med. Andreas Jokuszies

  2. Klinik und Poliklinik für Plastische, Handund Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover

    Univ.-Prof. Dr. med. Peter M. Vogt

Authors
  1. Dr. med. Andreas Jokuszies
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  2. Univ.-Prof. Dr. med. Peter M. Vogt
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Jokuszies, A., Vogt, P.M. (2011). Rekonstruktion an der unteren Extremität. In: Praxis der Plastischen Chirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-37573-9_27

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  • DOI: https://doi.org/10.1007/978-3-540-37573-9_27

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-37571-5

  • Online ISBN: 978-3-540-37573-9

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