plastische, reconstructieve en esthetische chirurgie - UZ Leuven

HIERNER R., PEETERS W., REYNDERS P.: Simultaneousfree flap transfer in total knee arthroplasty in case ofinsufficiënt soft tissue prior to prosthetic implantation:indications and results. In: Proceedings of the 3rd congressof the world society for reconstructive microsurgery. Eds.: G.Loda, Monduzzi Editore, Milano, 2005: 35-46.Background: The purpose of this paper is to show ourpersonal experience with simultaneous free flap transferin total knee arthroplasty in case of insufficient softtissue prior to prosthetic implantation.Material and Methods: In retrospective clinical study 11patients who underwent simultaneous flap surgery in thecontext of total knee arthroplasty because of insufficientsoft tissue prior to implantation are reviewed. In 10patients a free myo-cutaneous latissimus dorsi flap andin 1 patient a pedicled medial gastrocnemius muscle flapin combination with a split thickness skin graft werecarried out. In a retrospective clinical study, thefollowing criteria were examined: 1) etiology of softtissue defect, 2) number of previous operations, 3) statusof the knee extensor mechanism judged as complete,partial, missing, 4) primary wound healing, 5)complications and 6) active range of motion.Result: Primary wound healing could be achieved in 6patients with a free myocutaneous latissimus dorsi flapand in the only patient with a pedicled medialgastrocnemius muscle flap. After free latissimus dorsitransfer skin breakdown of the recipient site occurred in4 patients. Secondary skin grafting was carried out in 3patients and a fascio-cutaneous flap in the remaining.Average active range of motion prior to combinedsurgery was for extension/flexion 0-7-27°. One year aftersurgery the average active ROM was 0-7-82°.Conclusions: A free flap transfer is indicated for defectswhich cannot be covered by a pedicled medialgastrocnemius flap. Free latissimus dorsi transfer makesprosthesis implantation possible, avoids a postoperativeknee stiffness because of soft tissue and/or scarconstriction, shows a low rate of severe complications inpatients with high risk of wound healing problems, andlead to an adequate, painless global knee function.Moreover, transfer of well vascularized tissue willimprove trophicity at the knee region, and makes futureoperations at this region possible.HIERNER R., VAN DEN KERCKHOVE E.: Ergebnisse derulno-dorsalen Lappenplastik nach interfaszikulärerNeurolyse des N. medianus im Handgelenksbereich.Handchir., Mikrochir., Plast. Chir., 2004.Einleitung: Mehrfache Revisionseingriffe aufgrundpersistierender Beschwerden am N. Medianus führen zueiner zunehmenden Fibrosierung des Gewebes um denNerven – Lager – und im Nerven selbst. Trotz technischeinwandfrei durchgeführter mikrochirurgischer Operationkann vor allemdie überempfindlichkeit im palmarenHandgelenksbereich oft nicht ausreichend beseitigtwerden.