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Wiederherstellung der verbrannten Extremität durch Transplantation freier Lappenplastiken

Reconstruction of burned extremities by free flap transplantation

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Zusammenfassung

Auch heute stellt die Rekonstruktion der verbrannten Extremität höchste Anforderungen an den plastischen Chirurgen, vor allem wenn mikrochirurgische Lappenplastiken indiziert sind. Anhand einer retrospektiven Analyse von 68 freien Lappenplastiken bei 55 Patienten werden die rekonstruktiven Prinzipien und ein Entscheidungsalgorithmus für die Primär- und Sekundärrekonstruktion der Extremitäten nach Verbrennung aufgezeigt. In der Primärversorgung bildete der Versuch des Extremitätenerhalts die wesentliche Indikation für 42 durchgeführte Lappenplastiken.Der Zeitpunkt der Rekonstruktion hat entscheidenden Einfluss auf das Ergebnis der mikrochirurgischen Operation. Die Lappenverlustrate betrug 24% bei der Primärversorgung; aufgrund der gesteigerten posttraumatischen Thrombogenität besteht das höchste Risiko eines Lappenverlustes zwischen dem 5. und dem 21. Tag (40%). In der Sekundärversorgung wurden 26 freie Lappenplastiken mit einer Erfolgsrate von 100% durchgeführt. Adipo- oder fasziokutane Lappenplastiken bieten mit ihrer Elastizität eine gute Option zur Auflösung narbiger Kontrakturen.

Die Vielfalt der Rekonstruktionsmöglichkeiten mit 19 verschiedenen Lappenplastiken, zeigt, dass die Verbrennungsrekonstruktion ein individuelles Konzept für jeden einzelnen Patienten sowie das gesamte Spektrum der plastisch-rekonstruktiven Chirurgie erfordert. Dies unterstreicht die enge Verbindung von Verbrennungsmedizin und plastisch-mikrochirurgischer Rekonstruktion, um betroffene Extremitäten erhalten und gleichzeitig Ästhetik und Funktion verbessern zu können.

Abstract

Free tissue transplantation in burn reconstruction presents a major challenge to reconstructive surgeons. The results of a retrospective analysis of 68 free flaps in 55 patients are reported. This experience facilitated the establishment of reconstructive principles and a decision-making algorithm for primary and secondary reconstruction of burned extremities. Fourty-two free flaps were used for primary reconstruction. The indications were predominantly extremity salvage.The safety of the microsurgical procedures is correlated with the timing of the reconstruction. The failure rate of the free flaps was 24% in primary reconstruction. Due to an increased post-traumatic thrombogenicity, the period between 5 and 21 days had the highest risk of flap failure (40%).Twenty-six flaps were used for secondary reconstruction, with a success rate of 100%. Due to their elasticity, adipo- and fasciocutaneous flaps provide a useful option for the release of contractures.

The large variability demonstrated by the use of 19 different types of free flaps showed that the reconstruction of burned extremities requires a reconstructive concept individualized to each patient as well as sophisticated microsurgical techniques. This clearly demonstrates the importance of a close link between primary burn treatment and reconstructive plastic surgery.

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Authors and Affiliations

  1. Klinik für Hand-, Plastische und Rekonstruktive Chirurgie—Schwerbrandverletztenzentrum, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Plastische und Handchirurgie der Universität Heidelberg, Ludwigshafen

    S. Baumeister, G. Germann, G. Giessler, A. Dragu & M. Sauerbier

  2. Klinik für Hand-, Plastische und Rekonstruktive Chirurgie—Schwerbrandverletztenzentrum, Berufsgenossenschaftliche Unfallklinik, Ludwig-Guttmann-Straße 13, 67071 , Ludwigshafen

    S. Baumeister

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  1. S. Baumeister
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  2. G. Germann
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  4. A. Dragu
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  5. M. Sauerbier
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Correspondence to S. Baumeister.

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Baumeister, S., Germann, G., Giessler, G. et al. Wiederherstellung der verbrannten Extremität durch Transplantation freier Lappenplastiken. Chirurg 75, 568–578 (2004). https://doi.org/10.1007/s00104-004-0861-5

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