Defektrekonstruktion nach onkologischer Resektion und Bestrahlung – Indikationen zur mikrochirurgischen Rekonstruktion

 

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Zusammenfassung

In der chirurgischen Therapie von Weichgewebssarkomen an den Extremitäten ist zum Erreichen einer lokalen Tumorkontrolle oftmals eine begleitende Radiatio indiziert. Neoadjuvante wie auch adjuvante Bestrahlung verursachen durch das Auftreten von Wundheilungsstörungen, Ulzera, Osteonekrose und Folgefrakturen jedoch gleichzeitig eine beträchtliche Morbiditätszunahme. Als Gründe finden sich gestörte Zellmediatorlevel, eine Fibrosierung bei gleichzeitig verminderter Zellteilungsrate und beeinträchtigte Durchblutung. Hier beschreiben wir mögliche lokale konservative Therapieverfahren, die allerdings insgesamt eher schlechte Erfolgsraten zeigen. Zusätzlich werden plastisch chirurgische Verfahren dargestellt, die eine Therapie dieser bestrahlungsinduzierten Probleme ermöglichen. Die chirurgische Rekonstruktion umfasst die komplette Bandbreite plastisch-rekonstruktiver Techniken, wobei einfache chirurgische Lösungen wie Random-Pattern-Lappen oder Spalthauttransplantion häufig mit Komplikationen vergesellschaftet sind, weshalb in einer großen Anzahl der Fälle ein freier Gewebetransfer notwendig werden kann.

Abstract

The surgical treatment of soft tissue sarcomas in the extremities frequently requires radiation therapy to achieve local tumour control. However, both adjuvant and neoadjuvant radiation are associated with significant morbidity caused by impaired wound healing, ulcers or osteonecrosis with subsequent fractures. This is due to altered local cell mediator levels, fibrosis occurring simultaneously with decreased cell division rates and diminished vascularity. This article describes a number of local conservative treatment options, all of which have limited success rates. In addition, it describes plastic surgical treatment options for radiation-induced local morbidity. Surgical reconstruction includes the full range of plastic reconstructive techniques. However, less complex options such as random pattern flaps or split thickness skin grafts are often associated with complications. Therefore, a large number of cases require free tissue transfer.

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