Der „anterolateral thigh perforator flap“ zur Deckung von Gesichtsdefekten nach Tumorchirurgie

Mund-, Kiefer- und Gesichtschirurgie - Tập 10 - Trang 315-323 - 2006
Alexander Gaggl1, Heinz Bürger2, Gerald Lesnik3, Ernst Müller2, Friedrich Chiari1
1Abteilung für Mund-, Kiefer- und Gesichtschirurgie, Landeskrankenhaus Klagenfurt, Klagenfurt, Österreich
2Abteilung für Unfallchirurgie, LKH Klagenfurt, Klagenfurt, Österreich
3Zentral-Röntgeninstitut, LKH Klagenfurt, Klagenfurt, Österreich

Tóm tắt

Die individuelle Designgestaltung mikrovaskulärer Transplantate und eine geringe Spendermorbidität sind wesentliche Kriterien in der Rekonstruktion ausgedehnter Gesichtsdefekte nach ablativer Tumorchirurgie. Durch die Verwendung mikrovaskulärer Perforatorlappenplastiken wird in den letzten Jahren versucht, einen neuen Ansatz zur Erlangung dieser Ziele zu finden. Im Folgenden wird das chirurgische Vorgehen bei der Hebung des „anterolateral thigh perforator flap“ (ALTPF) beschrieben und über eigene Erfahrungen berichtet sowie diese unter Berücksichtigung der bestehenden Literatur diskutiert. Bei 19 Patienten mit Plattenepithelkarzinomen des Mundbodens (8), des Wangenbereichs (6) und des Unterkiefers (5) im Stadium T3 oder T4 erfolgte neben einem ablativen tumorchirurgischen Vorgehen eine mikrochirurgische Rekonstruktion mit 19 ALTPF. Bei fünf Patienten wurde eine kombinierte Transplantation mit einem mikrovaskulären Beckentransplantat durchgeführt. Bei einem Patienten wurden intraoperativ die Perforansgefäße disseziert. Bei allen anderen Patienten waren der Operationsverlauf und die postoperative Phase komplikationsfrei. Bei fünf Patienten wurden kleinere Sekundärkorrekturen durchgeführt. Alle Patienten zeigten gute funktionelle und ästhetische Ergebnisse. Der „anterolateral thigh perforator flap“ bietet zahlreiche Vorteile in der Deckung von Gesichtsdefekten, wie eine zuverlässige kontrollierbare zentrale Perfusion, sichere individuelle Designgestaltung und eine geringe Entnahmemorbidität.

Tài liệu tham khảo

Angrigiani C, Grillin D, Siebert J (1995) Latissimus dorsi musculocutaneous flap without muscle. Plast Reconstr Surg 96:1608–1614 Ao M, Uno K, Maeta M et al. (1999) De-epithelialised anterior thigh flaps for dead space fillings and contour correction in head and neck reconstruction. Br Plast Surg 52:261–267 Blackwell KE (1998) Donor site evaluation for fibula free flap transfer. Am J Otolaryngol 19:89–95 Calikapan GT, Yildirim S, Akoz T (2006) One-stage reconstruction of large scalp defects: anterolateral thigh flap. Microsurgery 26:155–159 Cavadas PC, Teran-Saavedra PP (2002) Combined latissimus dorsi-thoracodorsal artery perforator free flap: the “razorflap”. J Reconstr Microsurg 18:29–31 Chana JS, Wei FC (2004) A review of the advantages of the anterolateral thigh flap in head and neck reconstruction. Br J Plast Surg 57:603–609 Chou EK, Ulusal B, Ulusal A et al. (2006) Using the descending branch of the femoral circumflex vessel as a source of two independent flaps. Plast Reconstr Surg 117:2059–2063 Cipriani R, Contedini F, Caliceti U, Cavina C (2002) Three-dimensional reconstruction of the oral cavity using the free anterolateral thigh flap. Plast Reconstr Surg 109:53–57 Demirkan F, Unai S, Arslan E, Gurbuz O (2003) Versatile anterolateral thigh perforator flap: a case of tailored reconstruction for a large temporal and parotidectomy defect. J Reconstr Microsurg 19:221–224 Gedebou TM, Wei FC, Lin CH (2002) Clinical experiences of 1284 free anterolateral thigh flaps. Handchir Mikrochir Plast Chir 34:239–244 Hariawala MD, Cohn WE, Tofukuji M et al. (1997) The latissimus dorsi-based fasciocutaneous flap. Ann Plast Surg 38:550 Head C, Alan D, Sercarz JA et al. (2003) Microvascular flap reconstruction of the mandible: a comparison of bone grafts and bridging plates for restoration of mandibular continuity. Otolaryngol Head Neck Surg 129:48–54 Hong JP, Choi JW, Chang H, Lee TJ (2005) Reconstruction of the face after resection of arteriovenous malformations using anterolateral thigh perforator flap. J Craniofac Surg 16:851–855 Jeng SF, Kuo YR, Wei FC, Su CY, Chien CY (2005) Reconstruction of extensive composite mandibular defects with large lip involvement by using double free flaps and fascia lata grafts for oral sphincters. Plast Reconstr Surg 115:1830–1836 Kim JT, Kim SK (2003) Hand resurfacing with the superthin latissimus dorsi perforator-based free flap. Plast Reconstr Surg 111:366–370 Kim JT, Koo BS, Kim SK (2001) The thin latissimus dorsi perforator-based free flap for resurfacing. Plast Reconstr Surg 107:374–382 Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42:645–648 Koshima I, Soeda S, Yamasaki M, Kyou J (1988) Free or pedicled anteromedial thigh flap. Ann Plast Surg 21:480–485 Koshima I, Fukuda H, Soeda S (1989) Free combined anterolateral thigh flap and vascularised iliac bone graft with double vascular pedicle. J Reconstr Microsurg 5:55–61 Koshima I, Hosoda M, Moroguchi T et al. (1993) A combined anterolateral thigh flap, anteromedial thigh flap, and vascularized iliac bone graft for a full-thickness defect of the mental region. Ann Plast Surg 31:175–180 Koshima I, Yamamoto H, Moriguchi T, Orita Y (1994) Extended anterior thigh flaps for repair of massive cervical defects involving pharyngoesophagus and skin: an introduction to the “mosaic” flap principle. Ann Plast Surg 32:321–327 Koshima I, Hosoda S, Inagawa K, Urushibara K, Morigushi T (1998) Free combined anterolateral thigh flap and vascularised fibula for wide through-and-through oromandibular defects. J Reconstr Microsurg 14:529–534 Lineaweaver W, Hui KC, Kaufmann D (1997) Cross-facial vein grafting in complicated flap reconstruction of the face and mandible. J Reconstr Microsurg 13:545–549 Ozkan O, Ozgentas HE, Dikici MB (2004) Simultaneous reconstruction of large maxillary and mandibular defects with a fibular osteocutaneous flap combined with an anterolateral thigh flap. J Reconstr Microsurg 20:451–455 Ozkan O, Mardini S, Chen HC et al. (2006) Repair of buccal defects with anterolateral thigh flaps. Microsurgery 26:182–189 Sanger JR, Yousif NJ, Matloub HS, Larson DL, Sewall SS (1994) Reconstruction of lower third of face with three simultaneous free flaps. Plast Reconstr Surg 94:709–713 Schoeller T, Huemer GM, Shafigi M et al.(2004) Free anteromedial thigh flap: clinical application and review of literature. Microsurgery 24:43–48 Urken ML, Buchbinder D, Constantino PD et al. (1998) Oromandibular reconstruction using microvascular composite flaps: report of 210 cases. Arch Otolaryngol Head Neck Surg 124:46–55 Urken ML, Weinberg H, Vickery C et al. (1991) Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects. Arch Otolaryngol Head Neck Surg 117:733–744 Urken ML, Buchbinder D, Weinberg H et al. (1992) Functional evaluation following microvascular oromandibular reconstruction of the oral cancer patient: a comparative study of reconstructed and nonreconstructed patients. Laryngoscope 102:725–726 Wang X, Qiao Q, Liu Z et al. (2005) Free anterolateral thigh adipofascial flap for hemifacial atrophy. Ann Plast Surg 55:617–622 Wei FC, Celik N, Chen HC, Cheng MH, Huang WC (2002) Combined anterolateral thigh flap and vascularised fibula osteocutaneous flap in reconstruction of extensive composite mandibular defects. Plast Reconstr Surg 109:45–52 Yazar S, Wie FC, Chen MH et al. (2005) Selection of recipient vessels in double free-flap reconstruction of composite head and neck defects. Plast Reconstr Surg 115:1553–1561 Yildirim S, Taylan G, Akoz T (2005) Use of fascia component of the anterolateral thigh flap for different reconstructive purposes. Ann Plast Surg 55:479–484 Yildirim S, Gideroglu K, Aydogdu E et al. (2006) Composite anterolateral thigh-fascia lata flap: a good alternative to radial forearm-palmaris longus flap for total lower lip reconstruction. Plast Reconstr Surg 117:2033–2041 Young DM, Trabulsy PP, Anthony JP (1994) The need for preoperative led angiography in fibula free flaps. J Reconstr Microsurg 10:283–287 Yu P, Lewin JS, Reece GP, Robb GL (2006) Comparison of clinical and functional outcomes and hospital costs following pharyngoesophageal reconstruction with the anterolateral thigh free flap versus the jejunal flap. Plast Reconstr Surg 117:968–974