{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T05:28:19Z","timestamp":1730870899384,"version":"3.28.0"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zentralbl Chir"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Komplexe, isch\u00e4mische Wunden im Bereich der unteren Extremit\u00e4t mit freiliegenden tiefen Strukturen stellen gro\u00dfe Herausforderungen an die behandelnden Fachdisziplinen dar. Als Alternative zur Majoramputation ergibt sich f\u00fcr ausgew\u00e4hlte Patienten die M\u00f6glichkeit eines kombinierten Verfahrens mittels arterieller Rekonstruktion und nachfolgender mikrochirurgischer Defektdeckung durch eine freie Lappentransplantation. Als arterielle Rekonstruktionsverfahren stehen endovaskul\u00e4re oder offen chirurgische Verfahren wie Bypassrekonstruktion oder Implantation eines arterioven\u00f6sen Loops als Vorbereitung f\u00fcr die Defektdeckung zur Verf\u00fcgung. Ziel der arteriellen Rekonstruktion ist die Schaffung einer ausreichenden Perfusion zur Defektdeckung an der Extremit\u00e4t sowie die Schaffung von Anschlussgef\u00e4\u00dfen f\u00fcr die Lappentransplantation. Die Auswahl des Lappens richtet sich u.\u00a0a. nach der Gr\u00f6\u00dfe und Ausdehnung des Defektes sowie nach dem Vorhandensein einer Osteomyelitis. Dies kann ein- oder\n      zweizeitig erfolgen. In Zentren ist dieses kombinierte Vorgehen als sichere Methode etabliert. Die Mikroperfusionsanalyse des Gewebes mittels Indocyaningr\u00fcn erh\u00f6ht nochmals die Sicherheit des Verfahrens und kann Perfusionsdefizite aufzeigen. Das kombinierte Verfahren mittels arterieller Rekonstruktion und freiem Gewebetransfer liefert gute Langzeitergebnisse im Hinblick auf amputationsfreies \u00dcberleben und postoperative Mobilit\u00e4t. Wichtig f\u00fcr die Indikationsstellung ist eine korrekte Patientenselektion unter Ber\u00fccksichtigung der Kontraindikationen. Dieses Verfahren sollte f\u00fcr alle mobilen Patienten mit komplexen Weichteildefekten vor einer Majoramputation evaluiert werden.<\/jats:p>","DOI":"10.1055\/a-2183-1770","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T00:19:36Z","timestamp":1699921176000},"page":"468-474","source":"Crossref","is-referenced-by-count":0,"title":["Revaskularisation vor Defektdeckung \u2013 essenzielle Schnittstelle zwischen plastischer Chirurgie und Gef\u00e4\u00dfchirurgie"],"prefix":"10.1055","volume":"149","author":[{"given":"Alexander","family":"Meyer","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Gef\u00e4\u00dfchirurgie, HELIOS Klinikum Berlin-Buch, Berlin, Deutschland"},{"name":"MSB Medical School Berlin, Berlin, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich","family":"Rother","sequence":"additional","affiliation":[{"name":"Gef\u00e4\u00dfchirurgische Abteilung, Universit\u00e4tsklinikum Erlangen, Erlangen, Deutschland"},{"name":"Friedrich-Alexander-Universit\u00e4t, Erlangen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver C.","family":"Thamm","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Plastische und \u00c4sthetische Chirurgie, HELIOS Klinikum Berlin-Buch, Berlin, Deutschland"},{"name":"Universit\u00e4t Witten-Herdecke, Witten, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,11,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1016\/j.jvs.2014.12.005","article-title":"Results of combined vascular reconstruction and free flap transfer for limb salvage in patients with critical limb ischemia","volume":"61","author":"A Meyer","year":"2015","journal-title":"J Vasc Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.bjps.2015.11.025","article-title":"Results of combined vascular reconstruction by means of AV loops and free flap transfer in patients with soft tissue defects","volume":"69","author":"A Meyer","year":"2016","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1111\/iwj.12282","article-title":"Distal pedal bypasses combined with free microsurgical flaps in chronic limb ischaemia for problematic wounds","volume":"13","author":"RE Horch","year":"2016","journal-title":"Int Wound J"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1016\/j.bjps.2020.10.045","article-title":"Combined (endo-)vascular intervention and microsurgical lower extremity free flap reconstruction \u2013 A propensity score matching analysis in 5386 ACS-NSQIP patients","volume":"74","author":"V Haug","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1016\/j.ejvs.2009.06.005","article-title":"A 15-year experience with combined vascular reconstruction and free flap transfer for limb-salvage","volume":"38","author":"C Randon","year":"2009","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1097\/01.sla.0000247985.45541.e8","article-title":"Advanced leg salvage of the critically ischemic leg with major tissue loss by vascular and plastic surgeon teamwork: Long-term outcome","volume":"244","author":"E Tukiainen","year":"2006","journal-title":"Ann Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1055\/s-0034-1385851","article-title":"[Reconstruction of the vascular compromised lower extremity \u2013 report of the consensus workshop at the 35. 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