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Elevation Technique for Medial Branch based Superficial Circumflex Iliac Artery Perforator flap


Elevation Technique for Medial Branch based Superficial Circumflex Iliac Artery Perforator flap



Handchirurgie Mikrochirurgie Plastische Chirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie: Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefasse: Organ der V. 50(4): 256-258



ISSN/ISBN: 1439-3980

PMID: 30130835

DOI: 10.1055/a-0631-9180

Erste anatomische Untersuchungen der A. circumflexa iliaca superficialis-Perforans-Lappenplastik (SCIP-Flap) haben gezeigt, dass zwei Typen der Blutversorgung von Perforans-Gefäßen aus der A. circumflexa ilaca superficialis zu unterscheiden sind: 1. der mediale Ast mit einem direkten Perforans-Gefäß (oberflächlicher Ast) – relativ medial auf der Lappenplastik gelegen, und 2. das laterale Perforans-Gefäß, lateral unter der tiefen Faszie verlaufend und oft intramuskulär verlaufend und die tiefe Faszie erst lateral perforierend (tiefer Ast). Obwohl es gut beschriebene Studien zur Anatomie des arteriellen Gefäßsystems gibt, verlaufen die Planung und die tatsächliche Hebung der Lappenplastik oft unterschiedlich, da es oft anatomische Variationen gibt, wie etwa in Bezug auf die Anatomie des Pedikels, die Lage der Lymphknoten und die Dicke von oberflächlichen Faszie. Eine A. pudenda und A. epigastrica superficialis in der Leiste können für zusätzliche Verwirrung sorgen. Man sollte auch auf die Integrität der großen Lymphgefäße achten, die in das oberflächliche venöse System abgeleiten. Daher wird der vorliegende Beitrag, die auf dem medialen Perforans-Gefäß basierende Hebetechnik zu beschreiben und zu vereinfachen. Man muss jedoch immer bereit sein, ein gutes Perforans-Gefäß zu identifizieren und dieses als in einem „Freestyle“-Ansatz zu nutzen, wo auch immer das Perforans-Gefäß herkommt. Natürlich ist der beste Weg eine Perforans-Lappenplastik schnell und erfolgreich zu heben Übung.Das gilt für den SCIP Flap, der auf dem medialen Perforans-Gefäß basiert. Der direkte kutane Weg des Perforans-Gefäßes macht die Lappenhebung einfacher, da weder Muskel noch Lymphknoten präpariert werden müssen. Der vorliegende technische Hinweis beschreibt praktische, chirurgische Tipps.

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