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Der freie ALT-Oberschenkellappen in der traumatologischen und onkologischen Defektdeckung

Anterolateral thigh flaps for reconstruction of traumatological and oncological defects

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Zusammenfassung

Hintergrund

Seit 2005 wird der freie anterolaterale Oberschenkellappen (ALT) zur Defektdeckung im Bereich der oberen und unteren Extremität in unserer Klinik eingesetzt. Die Indikationen für den Lappentransfer sind vielfältig und umfassen u. a. posttraumatische Defekte, Defekte infolge von akuten und chronischen Infektionen und Weichteildefekte nach onkologischen Resektionen.

Patienten

Das Patientenkollektiv umfasste 58 Patienten, die im Zeitraum von Januar 2005 bis März 2007 60 ALT-Lappen in mikrochirurgischer Technik erhielten. Wir operierten 19 Frauen und 39 Männer mit einem Durchschnittsalter von 50,9 (16–84) Jahren.

Ergebnisse

Es kam insgesamt zu 3 kompletten Lappenverlusten (5%). Bei 35,0% Patienten konnten wir Majorkomplikationen dokumentieren. Dazu zählten Anastomosenrevisionen (20%) und partielle Lappennekrosen (10%). Minorkomplikationen wie Schwellung (3,3%), Wundheilungsstörungen (23,3%) und Hämatome (11,7%) traten bei 38,3% der Patienten auf. Die Operationsdauer betrug im Durchschnitt 282 (69–544) min.

Schlussfolgerung

Die Analyse der ersten 60 ALT-Lappenplastiken nach intra- und postoperativen Komplikationen zeigte, dass der ALT-Lappen Vorteile gegenüber anderen Lappenplastiken hat und nicht mehr aus unserem klinischen Alltag wegzudenken ist.

Abstract

Background

The anterolateral thigh flap (ALT) has become one of the most preferred options for soft tissue defect reconstruction in Asia with an increasing popularity in Europe. The article presents the authors’ experience using the ALT flap for various indications in the upper and lower extremities.

Methods

Between January 2005 and March 2007, 60 free ALT flaps were operated for reconstruction of various soft tissue defects. The causes of soft tissue defects included trauma (13), infection (26), and sarcoma resection (21). We operated on 39 male and 19 female patients with an average age of 50.9 years (range: 16–84 years).

Results

The flap survival rate was 95.0% percent (57 of 60 flaps); 5% of the flaps died. The donor site was closed primarily in all cases. Donor site complications were minimal. The average operative time was 282 min (69–544 min). Flap-related major complications occurred in 35.0% of patients including reexploration of the anastomoses and partial flap necrosis. Minor complications, e.g., wound infection, hematoma, and swelling were seen in 23 cases.

Conclusions

Our experience indicates that the free ALT flap is a reliable method for soft tissue defect reconstruction. The use of the ALT offers many advantages such as a long and large caliber vascular pedicle, a large skin island as well as minimal donor site morbidity. The surgery can simultaneously performed by two teams with the patient in a supine position.

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Authors and Affiliations

  1. Klinik für Plastische Chirurgie und Schwerbrandverletzte – Handchirurgiezentrum, operatives Referenzzentrum für Extremitätentumore, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    S. Langer, L. Steinsträßer, M. Lehnhardt, N. Strack, H.U. Steinau, A. Daigeler & H.H. Homann

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  1. S. Langer
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  2. L. Steinsträßer
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  3. M. Lehnhardt
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  4. N. Strack
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  5. H.U. Steinau
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  6. A. Daigeler
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  7. H.H. Homann
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Correspondence to S. Langer.

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Langer, S., Steinsträßer, L., Lehnhardt, M. et al. Der freie ALT-Oberschenkellappen in der traumatologischen und onkologischen Defektdeckung. Unfallchirurg 111, 323–330 (2008). https://doi.org/10.1007/s00113-007-1355-y

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  • DOI: https://doi.org/10.1007/s00113-007-1355-y

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