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Gefäßgestielte Arteria-peronea-Perforatorlappenplastik

Peroneal artery perforator flap

  • Operative Techniken
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Rekonstruktion von Hautweichteildefekten im Bereich der distalen unteren Extremität durch Verlagerung einer vaskularisierten fasziokutanen Lappenplastik.

Indikation

Defektdeckung im Bereich des mittleren und distalen Drittels des lateralen Unterschenkels, des Malleolus lateralis sowie der Achillessehne.

Kontraindikation

Läsion bzw. Verschluss der Arteria peronea, traumatisierte Hautweichteilverhältnisse im Bereich des lateralen Unterschenkels, tiefe Beinvenenthrombose.

Operationstechnik

Präoperative Lokalisation des dominanten Perforansgefäßes mittels Dopplerultraschall bzw. Duplexsonographie oder (Computertomographie)-Angiographie. Zunächst unilaterale Hautinzision, Darstellen des Perforansgefäßes und Skelettierung bis an die Arteria peronea. Komplette Umschneidung der Lappenplastik, Schonung von sekundären Perforansgefäßen. Bei adäquater Lappenperfusion Transfer der Lappenplastik in den Defekt, entweder mittels Vorschub oder als Propellerlappenplastik. Direkter Verschluss des Entnahmedefekts oder Spalthauttransplantation.

Weiterbehandlung

Hochlagerung der unteren Extremität für 5 Tage. Anschließend vorsichtige elastokompressive Wickelung und orthostatisches Lappentraining mit steigender Intensität. Postoperativ Kompressionstherapie, ggf. Narbentherapie.

Ergebnisse

Bei minimalem funktionellem Entnahmedefekt ausgezeichnete funktionelle und ästhetische Ergebnisse.

Abstract

Objective

Defect reconstruction at the distal lower extremity by transposition of a vascularised fasciocutaneous flap.

Indications

Reconstruction of defects at the lateral aspect of the middle and distal third of the lower leg, the lateral ankle and achilles tendon region.

Contraindications

Lesions or occlusion of the peroneal artery, traumatized skin and soft tissues at the donor site of the flap, deep vein thrombosis of the ipsilateral leg.

Surgical technique

Preoperative localisation of the dominant perforator using Duplex or Doppler ultrasound or CT-angiography. Initially limited skin incision and identification and microsurgical dissection of the dominant perforator up to its origin from the peroneal artery. Completion of skin incision and mobilisation of the flap while the secondary perforans vessels are still preserved. Evaluation of flap perfusion and transfer of the flap into the defect by advancement or 180° rotation as a propeller flap. Closure of the donor site defect by direct suture or skin grafts.

Postoperative management

Elevation of the extremity for 5 days. Elastocompressive garments and orthostatic training with increasing intensity. Standardised postoperative compression therapy and scar therapy if necessary.

Results

Minimal functional donor site defect and optimal functional and aesthetic results.

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Authors and Affiliations

  1. Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland

    U. Kneser, J.P. Beier, A. Dragu, A. Arkudas & R.E. Horch M.D.

  2. Klinik für Hand, Plastische und Rekonstruktive Chirurgie - Schwerbrandverletzenzentrum, Klinik für Plastische Chirurgie, Ruprecht-Karls-Universität Heidelberg, BG - Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland

    U. Kneser

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  1. U. Kneser
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  2. J.P. Beier
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  3. A. Dragu
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  4. A. Arkudas
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  5. R.E. Horch M.D.
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Correspondence to U. Kneser.

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Kneser, U., Beier, J., Dragu, A. et al. Gefäßgestielte Arteria-peronea-Perforatorlappenplastik. Oper Orthop Traumatol 25, 170–175 (2013). https://doi.org/10.1007/s00064-012-0200-9

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  • DOI: https://doi.org/10.1007/s00064-012-0200-9

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