Muss es immer das Abdomen sein? – Alternative Lappen zur mikrochirurgischen Brustrekonstruktion

Die DIEP- (Deep inferior epigastric Perforator) oder muskelsparende transverse Rectus-abdominis-Myokutan-Lappenplastik (ms-TRAM) gilt als Gold-Standard in der autologen Brustrekonstruktion bei post-Mastektomie Patientinnen. Einige Patientinnen sind aus verschiedenen Gründen keine geeigneten Kandidatinnen für eine Gewebeentnahme am Bauch. In diesen Fällen stehen diverse andere Hebestellen am Oberschenkel (transverse und diagonale myokutane musculus gracilis Lappenplastik, profunda artery perforator Lappenplastik, lateral thigh perforator Lappenplastik), am Stamm (Lumbalarterienperforator-Lappenplastik) und aus der Gesäßregion (superiore und inferiore Glutealarterien und fasziokutane infragluteale Lappenplastik) zu Verfügung. Dieser Artikel gibt einige Einblicke in die Historie, die relevante Anatomie, die chirurgische Technik und neue Anwendungen wie die Neurotisation alternativer Lappenplastiken zur autologen Brustrekonstruktion.

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