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Mikrochirurgie bei Patienten mit arterieller Verschlusskrankheit

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Grundkurs Mikrochirurgie
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Zusammenfassung

Bei Patienten mit peripherer arterieller Verschlusskrankheit sind bei Gewebetransplantationen einige Besonderheiten im Vergleich zu bei gefäßgesunden Patienten zu beachten, die sich wesentlich auf den kompromittierten Einstrom, der Gefäßwandbeschaffenheit sowie die Strömungswiderstände im abführenden Gefäßschenkel beziehen. Durch die zunehmende Standardisierung Verbreitung der Mikrochirurgie stellen heute auch fortgeschrittene Gefäßveränderungen bei kritisch kranken Patienten keine Kontraindikation gegen mikrochirurgische Rekonstruktionen mehr dar. Im folgenden Kapitel werden interdisziplinäre Konzepte für diese spezielle Indikation der Mikrochirurgie beschrieben.

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Literatur

  • Abdelsalam H, Markose G, Bolia A (2008) Revascularization strategies in below the knee interventions. The Journal of cardiovascular surgery 4 9(2): 187–91

    Google Scholar 

  • Adam DJ, Beard JD, Cleveland T et al. (2005) Bypass versus angioplasty in severe ischaemia of the leg (BASIL): multicentre, randomised controlled trial. Lancet 366(95 01): 1925–34

    Google Scholar 

  • Aust MC, Spies M, Guggenheim M et al. (2008) Lower limb revascularisation preceding surgical wound coverage - an interdisciplinary algorithm for chronic wound closure. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 6 1(8): 925–33

    Article  Google Scholar 

  • Bergman BA, Zamboni WA, Brown RE (1992) Microvascular anastomosis of a rectus abdominis free flap into a prosthetic vascular bypass graft. Journal of reconstructive microsurger y 8(1): 9–12

    Google Scholar 

  • Brillu C, Picquet J, Villapadierna F et al. (2001) Percutaneous transluminal angioplasty for management of critical ischemia in arteries below the knee. Annals of vascular surgery 1 5(2): 175–81

    Article  Google Scholar 

  • Daigeler A, Kneser U, Fansa H, Riester T, Uder M, Horch RE (2014) [Reconstruction of the Vascular Compromised Lower Extremity - Report of the Consensus Workshop at the 35. Meeting of the DAM (Deutschsprachige Gemeinschaft fur Mikrochirurgie der peripheren Nerven und Gefasse) 2013 in Deidesheim]. Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefässe 46(4): 248-55 (Rekonstruktion der vaskular kompromittierten unteren Extremitat - Bericht des Consensus-Workshops im Rahmen der 35. Jahrestagung der DAM 2013 in Deidesheim)

    Google Scholar 

  • Eweida AM, Lang W, Schmitz M, Horch RE (2013) Salvage of a free radial forearm flap by creation of an arteriovenous fistula at the distal arterial pedicle. Microsurgery 33(5): 391–5

    Article  PubMed  Google Scholar 

  • Ferraresi R, Centola M, Biondi-Zoccai G (2012) Advances in below-the-knee drug-eluting balloons. The Journal of cardiovascular surgery 5 3(2): 205–13

    Google Scholar 

  • Fischer S, Klinkenberg M, Behr B et al. (2013) Comparison of donor-site morbidity and satisfaction between anterolateral thigh and parascapular free flaps in the same patient. Journal of reconstructive microsurgery. 2 9(8): 537–44

    Google Scholar 

  • Fitzgerald O’Connor EJ, Vesely M, Holt PJ, Jones KG, Thompson MM, Hinchliffe RJ (2011) A systematic review of free tissue transfer in the management of non-traumatic lower extremity wounds in patients with diabetes. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 41(3): 391–9

    Google Scholar 

  • Fusaro M, Dalla Paola L, Biondi-Zoccai G (2007) Pedal-plantar loop technique for a challenging below-the-knee chronic total occlusion: a novel approach to percutaneous revascularization in critical lower limb ischemia. The Journal of invasive cardiology 19(2): E34–7

    Google Scholar 

  • Graziani L, Silvestro A, Bertone V et al. (2007) Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 3 3(4): 453–60

    Google Scholar 

  • Horch RE, Dragu A, Lang W et al. (2008) Coverage of exposed bones and joints in critically ill patients: lower extremity salvage with topical negative pressure therapy. Journal of cutaneous medicine and surgery 12(5):223–9

    Google Scholar 

  • Horch RE, Horbach T, Lang W (2007) The nutrient omentum free flap: revascularization with vein bypasses and greater omentum flap in severe arterial ulcers. Journal of vascular surgery 4 5(4): 837–40

    Google Scholar 

  • Horch RE, Lang W, Arkudas A et al. (2014) Nutrient free flaps with vascular bypasses for extremity salvage in patients with chronic limb ischemia. The Journal of cardiovascular surgery 55(2 Supp l 1): 265–72

    Google Scholar 

  • Hunter JE, Teot L, Horch R, Banwell PE (2007) Evidence-based medicine: vacuum-assisted closure in wound care management. International wound journal 4(3): 256–69

    Article  PubMed  Google Scholar 

  • Illig KA, Moran S, Serletti J et al. (2001) Combined free tissue transfer and infrainguinal bypass graft: an alternative to major amputation in selected patients. Journal of vascular surgery 33(1): 17–23

    Google Scholar 

  • Kasabian AK, Glat PM, Eidelman Y, Karp N, Giangola G (1995) Limb salvage with microvascular free flap reconstruction using simultaneous polytetrafluoroethylene graft for inflow. Annals of plastic surgery 35(3): 310–5

    Article  CAS  PubMed  Google Scholar 

  • Keagy BA, Schwartz JA, Kotb M, Burnham SJ, Johnson G, Jr (1986) Lower extremity amputation: the control series. Journal of vascular surgery 4(4): 321–6

    Google Scholar 

  • Kneser U, Arkudas A, Beier JP et al. (2013) [Extended skin and soft tissue defects after vascular wounds: plastic surgical concepts]. Zentralblatt fur Chirurgie 138(5): 536-42 (Ausgedehnte Gewebedefekte bei vaskularen Wunden - Möglichkeiten der plastische n Chirurgie)

    Google Scholar 

  • Kneser U, Beier JP, Schmitz M et al. (2014) Zonal perfusion patterns in pedicled free-style perforator flaps. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 67(1): e9–17

    Article  PubMed  Google Scholar 

  • LaMuraglia GM, Conrad MF, Chung T, Hutter M, Watkins MT, Cambria RP (2009) Significant perioperative morbidity accompanies contemporary infrainguinal bypass surgery: an NSQIP report. Journal of vascular surgery 50(2): 2 99-304, e1–4

    Google Scholar 

  • Lang W, Horch RE (2006) [Distal extremity reconstruction for limb salvage in diabetic foot ulcers with pedal bypass, flap plasty and vacuum therapy]. Zentralblatt fur Chirurgie 131(1): S146-50 (Distale Extremitatenrekonstruktion mit pedalem Bypass und Lappenplastiken beim diabetischen Fusssyndrom nach Vakuumvo rbehandlung)

    Google Scholar 

  • Lepantalo M, Biancari F, Tukiainen E (2000) Never amputate without consultation of a vascular surgeon. Diabetes/ metabolism research and reviews 1 6(1): S27–32

    Google Scholar 

  • Lepantalo M, Kallio M, Tukiainen E. (2010) Comment on: »A 15-year experience with combined vascular reconstruction and free flap transfer for limb-salvage«, C. Randon, B. Jacobs, F. De Ryck, K. Van Landuyt, F. Vermassen Eur. J Vasc Endovasc Surg 38(3): 338-345. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 39(5): 654–5

    Google Scholar 

  • Lipsky BA, Berendt AR, Deery HG et al. (2004) Diagnosis and treatment of diabetic foot infections. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 39 (7): 885–910

    Google Scholar 

  • Lipsky BA, Berendt AR, Deery HG et al. (2006) Diagnosis and treatment of diabetic foot infections. Plastic and reconstructive surgery 117(7 Supp l): 212S–38S

    Google Scholar 

  • Lorenzetti F, Giordano S, Tukiainen E (2012) Intraoperative hemodynamic evaluation of the latissimus dorsi muscle flap: a prospective study. Journal of reconstructive microsurgery 28(4): 273–8

    Google Scholar 

  • Lorenzetti F, Tukiainen E, Alback A, Kallio M, Asko-Seljavaara S, Lepantalo M (2001) Blood flow in a pedal bypass combined with a free muscle flap. European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 22(2): 161–4

    Google Scholar 

  • Luther M (1997) Surgical treatment for chronic critical leg ischaemia: a 5 year follow-up of socioeconomic outcome. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 13(5): 452–9

    Google Scholar 

  • Luther M (1998) Surgical treatment of chronic critical leg ischaemia. A five-year follow-up of survival, mobility, and treatment level. The European journal of surgery = Acta chirurgica 1 64(1): 35–43

    Google Scholar 

  • Mackey WC, McCullough JL, Conlon TP et al. (1986) The costs of surgery for limb-threatening ischemia. Surgery 99(1): 26–35

    CAS  PubMed  Google Scholar 

  • Malikov S, Casanova D, Champsaur P, Magnan PE, Branchereau A (2004) The bypass flap: an innovative technique of distal revascularization - anatomical study and clinical application. Annals of vascular surgery 1 8(5): 535–43

    Article  Google Scholar 

  • Malikov S, Casanova D, Magnan PE, Branchereau A, Champsaur P (2005) Anatomical bases of the bypass-flap: study of the thoracodorsal axis. Surgical and radiologic anatomy : SRA 27(2): 86–93

    Google Scholar 

  • Malikov S, Magnan PE, Casanova D et al. (2009) Bypass flap reconstruction, a novel technique for distal revascularization: outcome of first 10 clinical cases. Annals of vascular surgery 2 3(6): 745–52

    Article  Google Scholar 

  • Malsiner CC, Schmitz M, Horch RE, Keller AK, Leffler M (2013) Vessel transformation in chronic wounds under topical negative pressure therapy: an immunohistochemical analysis. International woun d journal 12(5): 501–9

    Google Scholar 

  • Mimoun M, Hilligot P, Baux S (1989) The nutrient flap: a new concept of the role of the flap and application to the salvage of arteriosclerotic lower limbs. Plastic and reconstructive surgery 8 4(3): 458–67

    Google Scholar 

  • Moran SL, Salgado CJ, Serletti JM (2004) Free tissue transfer in patients with renal disease. Plastic and reconstructive surgery 113 (7): 2006–11

    Google Scholar 

  • Randon C, Jacobs B, De Ryck F, Van Landuyt K, Vermassen F (2009) A 15-year experience with combined vascular reconstruction and free flap transfer for limb-salvage. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 3 8(3): 338–45

    Google Scholar 

  • Romiti M, Albers M, Brochado-Neto FC, Durazzo AE, Pereira CA, De Luccia N (2008) Meta-analysis of infrapopliteal angioplasty for chronic critical limb ischemia. Journal of vascular surgery 4 7(5): 975–81

    Google Scholar 

  • Salgado CJ, Smith A, Kim S et al. (2002) Effects of late loss of arterial inflow on free flap survival. Journal of reconstructive microsurgery 1 8(7): 579–84

    Google Scholar 

  • Salmi AM, Tierala EK, Tukiainen EJ, Asko-Seljavaara SL (1995) Blood flow in free muscle flaps measured by color Doppler ultrasonography. Microsurgery 16 (10): 666–72

    Article  CAS  PubMed  Google Scholar 

  • Schirmer S, Ritter RG, Fansa H (2013) Vascular surgery, microsurgery and supramicrosurgery for treatment of chronic diabetic foot ulcers to prevent amputations. PloS one 8(9): e7470–4

    Google Scholar 

  • Schirmer S, Ritter RG, Rice A, Frerichs O, Wehage IC, Fansa H (2011) [Preventing lower limb amputations in patients suffering from diabetic foot syndrome and peripheral vascular disease - opportunities and limitations]. Handchirurgie, Mikrochirurgie, plastische Chirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse 43(6):338-44. Grenzen und Moglichkeiten der Vermeidung von Majoramputationen der unteren Extremitat bei Diabetischem Fusssyndrom und arterieller Verschlusskrankheit durch freien Gew ebetransfer

    Google Scholar 

  • Sonntag BV, Murphy RX, Jr., Chernofsky MA, Chowdary RP (1995) Microvascular steal phenomenon in lower extremity reconstruction. Annals of plastic surgery 34(3):336-9; dis cussion 9–40

    Google Scholar 

  • Sumpio BE, Armstrong DG, Lavery LA, Andros G (2010) The role of interdisciplinary team approach in the management of the diabetic foot: a joint statement from the Society for Vascular Surgery and the American Podiatric Medical Association. Journal of vascular surgery 5 1(6): 1504–6

    Google Scholar 

  • Tukiainen E, Biancari F, Lepantalo M (2000) Lower limb revascularization and free flap transfer for major ischemic tissue loss. World journal of surgery 24 (12): 1531–6

    Google Scholar 

  • Tukiainen E, Kallio M, Lepantalo M (2006) Advanced leg salvage of the critically ischemic leg with major tissue loss by vascular and plastic surgeon teamwork: Longterm outcome. Annals of surgery 244(6): 949-57; dis cussion 57–8

    Article  Google Scholar 

  • Vacuum assisted closure: recommendations for use. A consensus document. International wound journal. 2008; 5 Sup pl 4: iii–19

    Google Scholar 

  • Veith FJ, Gupta SK, Wengerter KR et al. (1990) Changing arteriosclerotic disease patterns and management strategies in lower-limb-threatening ischemia. Annals of surgery 212(4):402-12; dis cussion 12–4

    Article  Google Scholar 

  • Walgenbach KJ, Voigt M, Horch R, Stark GB (1998) [Surgicallyinduced angiogenesis as basic principle in treatment ov hypovascularized wounds–the nutritive flap]. Langenbecks Archiv fur Chirurgie Supplement Kongressband Deutsche Gesellschaft fur Chirurgie Kongress. 115: 1186- 8 (Chirurgisch induzierte Angiogenese als Grundlage der Behandlung hypovaskularisierter Wunden - der nutritive Lappen)

    Google Scholar 

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Horch, R. (2016). Mikrochirurgie bei Patienten mit arterieller Verschlusskrankheit. In: Kneser, U., Horch, R., Lehnhardt, M. (eds) Grundkurs Mikrochirurgie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48037-3_29

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  • DOI: https://doi.org/10.1007/978-3-662-48037-3_29

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-48036-6

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