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Lappenplastiken zur Defektdeckung am distalen Unterschenkel

Flaps for soft tissue defect closure in the distal lower leg

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Zusammenfassung

Weichteildefekte am distalen Unterschenkel stellen, insbesondere im Rahmen eines Traumas, eine große Herausforderung dar. Um frühzeitig eine Defektdeckung zu erzielen, können neben freien Lappen auch gestielte adipofasziale oder Muskellappen zur Anwendung kommen. Der gestielte, adipofasziale Suralislappen ist mit einer sicheren Blutversorgung und großem Schwenkradius ausgestattet, sodass er sich sehr gut zur Deckung fast aller Weichteildefekte am distalen Unterschenkel eignet, so lange die Defektgröße 10 cm × 10 cm nicht überschreitet. Der Hebedefekt führt zu keinen wesentlichen Problemen und wird gut toleriert. Der Soleuslappen kann mit seinem Muskelbauch Weichteildefekte im mittleren und proximalen distalen Drittel des Unterschenkels erreichen. Der Hebedefekt ist manchmal mit einer verminderten Wadenfunktion verbunden, was aber meist gut toleriert wird. Aufgrund dieser Möglichkeiten können Defekte am distalen Unterschenkel mit Suralis- oder Soleuslappen gedeckt und dadurch eine freie mikrovaskuläre Lappenplastik vermieden werden.

Abstract

Soft tissue defects in the distal lower leg region are challenging to treat, especially in trauma cases. To achieve early closure of the defect, pediculated adipofascial or muscle flaps can be used as well as free flaps. The pediculated adipofascial suralis flap has a reliable blood supply and a broad radius so this flap can be used for almost every defect location on the distal lower leg except for defects larger than 10 × 10 cm. The donor site defect does not lead to major problems and is well tolerated. The soleus flap can cover defects in the middle third and proximal distal third of the lower leg with its muscle. The donor site defect is occasionally associated with reduced calf functioning but is tolerated well most of the time. Because of these advantages, the pediculated adipofacial suralis flap and the soleus muscle flap can be used instead a microvascular free flap for the closure of defects in the distal lower leg region.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A.J. Suda, P. Thoele und V.G. Heppert geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung für Septische Chirurgie, Knochen-, Gelenk- und Protheseninfektionen, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Straße 13, 67071, Ludwigshafen, Deutschland

    A.J. Suda, P. Thoele & V.G. Heppert

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  1. A.J. Suda
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  2. P. Thoele
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  3. V.G. Heppert
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Correspondence to A.J. Suda.

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Suda, A., Thoele, P. & Heppert, V. Lappenplastiken zur Defektdeckung am distalen Unterschenkel. Unfallchirurg 117, 61–71 (2014). https://doi.org/10.1007/s00113-013-2528-5

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