{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T23:47:09Z","timestamp":1764028029274,"version":"3.45.0"},"reference-count":32,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zentralbl Chir"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title>\n                  <jats:p>Ausgedehnte Thoraxwanddefekte k\u00f6nnen durch die Resektion maligner Tumoren oder durch eine Sternumosteomyelitis nach kardiochirurgischen Eingriffen entstehen. Das Ziel dieser Studie ist es, die Durchf\u00fchrbarkeit der Rekonstruktion mit freien Lappenplastiken unter Ber\u00fccksichtigung der Anschlussgef\u00e4\u00dfsituation, operative Komplikationen und das rekonstruktive Ergebnis zu analysieren.<\/jats:p>\n                  <jats:p>In der bizentrischen retrospektiven klinischen Studie wurden alle Patienten eingeschlossen, bei denen im Zeitraum Januar 2013 bis September 2024 eine freie Lappenplastik zur Rekonstruktion eines ausgedehnten Thoraxwanddefektes transplantiert wurde. Das Ziel war es, operative Details und Ergebnisse sowie Komplikationsraten auszuwerten. In einer Subgruppenanalyse wurden au\u00dferdem Komplikationen und Ergebnisse von Lappenplastiken, bei denen zus\u00e4tzlich eine arterioven\u00f6ser Gef\u00e4\u00dfschleife (AVL) als Anschlussgef\u00e4\u00df notwendig war, mit denen ohne zus\u00e4tzliche gef\u00e4\u00dfchirurgische Ma\u00dfnahmen verglichen.<\/jats:p>\n                  <jats:p>Insgesamt wurde bei 107 Patienten (n\u00a0=\u00a066, 62% nach herzchirurgischer Operation; n\u00a0=\u00a041, 38% nach onkologischer Operation) eine Thoraxwandrekonstruktion mit einer freien myokutanen Tensor-fasciae-latae- (TFL, n\u00a0=\u00a047, 44%), myokutanen Vastus-lateralis-Muskellappenplastik (VL, n\u00a0=\u00a037, 35%), kombinierten Vastus-lateralis-Anterior-lateral-Thigh- (kVL-ALT, n\u00a0=\u00a017, 16%), kombinierten Vastus-lateralis-Tensor-fasciae-latae-Muskellappenplastik (kVL-TFL, n\u00a0=\u00a02, 2%), einer Anterior-lateral-Thigh- (ALT, n\u00a0=\u00a02, 2%) oder einer transversen Rectus-abdominis-Muskellappenplastik (TRAM, n\u00a0=\u00a02, 2%) durchgef\u00fchrt. Bei 39 Rekonstruktion (36%) war simultan eine AVL-Anlage notwendig. Insgesamt traten postoperativ 6 Thrombosen der Lappenstielgef\u00e4\u00dfe auf (6%). Vollst\u00e4ndige Lappennekrosen traten in 3 F\u00e4llen (3%; VL, n\u00a0=\u00a02; kVL-ALTL, n\u00a0=\u00a01) und partielle Lappennekrosen traten bei 8 Lappenplastiken auf (8%; TFL, n\u00a0=\u00a03; kVL-ALT, n\u00a0=\u00a02; VL, n\u00a0=\u00a02; TRAM, n\u00a0=\u00a01). Der Vergleich postoperativer chirurgischer\n        Komplikationen zwischen Rekonstruktionen mit und ohne simultane AVL-Anlage zeigte keine signifikanten Unterschiede hinsichtlich ven\u00f6ser Thrombosen (n\u00a0=\u00a00 vs. n\u00a0=\u00a03), arterieller Thrombosen (n\u00a0=\u00a02 vs. n\u00a0=\u00a01), partieller Lappennekrose (n\u00a0=\u00a03 vs. n\u00a0=\u00a05) sowie totaler Lappennekrose (n\u00a0=\u00a00 vs. n\u00a0=\u00a03).<\/jats:p>\n                  <jats:p>Diese Studie zeigt, dass die Rekonstruktion ausgedehnter Thoraxwanddefekte mit freien VL- oder TFL-Lappenplastiken mit nur geringen Komplikationsraten durchf\u00fchrbar ist, auch wenn dies simultan eine AVL-Anlage erfordert.<\/jats:p>","DOI":"10.1055\/a-2637-5118","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T23:43:15Z","timestamp":1753141395000},"page":"474-483","source":"Crossref","is-referenced-by-count":0,"title":["Die Rekonstruktion komplexer Thoraxwanddefekte mit freien Lappenplastiken und die Wahl des richtigen Anschlussgef\u00e4\u00dfes"],"prefix":"10.1055","volume":"150","author":[{"given":"Florian","family":"Falkner","sequence":"first","affiliation":[{"name":"Klinik f\u00fcr Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland"},{"name":"Klinik f\u00fcr Hand-, Plastische- und Rekonstruktive Chirurgie, Chirurgische Universit\u00e4tsklinik Heidelberg, Heidelberg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca Luisa","family":"Sch\u00e4fer","sequence":"first","affiliation":[{"name":"Klinik f\u00fcr Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland"},{"name":"Klinik f\u00fcr Hand-, Plastische- und Rekonstruktive Chirurgie, Chirurgische Universit\u00e4tsklinik Heidelberg, Heidelberg, Deutschland"},{"name":"Department Chirurgie, Klinik f\u00fcr Hand-, Plastische und Rekonstruktive Chirurgie, Universitatsklinikum Freiburg, Freiburg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Mayer","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland"},{"name":"Klinik f\u00fcr Hand-, Plastische- und Rekonstruktive Chirurgie, Chirurgische Universit\u00e4tsklinik Heidelberg, Heidelberg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Ewerbeck","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland"},{"name":"Klinik f\u00fcr Hand-, Plastische- und Rekonstruktive Chirurgie, Chirurgische Universit\u00e4tsklinik Heidelberg, Heidelberg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7421-1213","authenticated-orcid":false,"given":"Riccardo","family":"Giunta","sequence":"additional","affiliation":[{"name":"Abteilung f\u00fcr Hand-, Plastische und \u00c4sthetische Chirurgie, Klinikum der Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, M\u00fcnchen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denis","family":"Ehrl","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Plastische, Wiederherstellende und Handchirurgie, Klinikum N\u00fcrnberg S\u00fcd, N\u00fcrnberg, Deutschland"},{"name":"Abteilung f\u00fcr Hand-, Plastische und \u00c4sthetische Chirurgie, Klinikum der Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, M\u00fcnchen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"M\u00f6llhoff","sequence":"additional","affiliation":[{"name":"Abteilung f\u00fcr Hand-, Plastische und \u00c4sthetische Chirurgie, Klinikum der Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, M\u00fcnchen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfram","family":"Demmer","sequence":"additional","affiliation":[{"name":"Abteilung f\u00fcr Hand-, Plastische und \u00c4sthetische Chirurgie, Klinikum der Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, M\u00fcnchen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanessa","family":"Masalov","sequence":"additional","affiliation":[{"name":"Abteilung f\u00fcr Hand-, Plastische und \u00c4sthetische Chirurgie, Klinikum der Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, M\u00fcnchen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emre","family":"Gazyakan","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland"},{"name":"Klinik f\u00fcr Hand-, Plastische- und Rekonstruktive Chirurgie, Chirurgische Universit\u00e4tsklinik Heidelberg, Heidelberg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Vogelpohl","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland"},{"name":"Klinik f\u00fcr Hand-, Plastische- und Rekonstruktive Chirurgie, Chirurgische Universit\u00e4tsklinik Heidelberg, Heidelberg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3402-2860","authenticated-orcid":false,"given":"Ulrich","family":"Kneser","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Klinik Ludwigshafen, Ludwigshafen, Deutschland"},{"name":"Klinik f\u00fcr Hand-, Plastische- und Rekonstruktive Chirurgie, Chirurgische Universit\u00e4tsklinik Heidelberg, Heidelberg, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6522-1312","authenticated-orcid":false,"given":"Felix Hubertus","family":"Vollbach","sequence":"additional","affiliation":[{"name":"Abteilung f\u00fcr Hand-, Plastische und \u00c4sthetische Chirurgie, Klinikum der Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, M\u00fcnchen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/j.jamcollsurg.2009.11.012","article-title":"Primary chest wall tumors","volume":"210","author":"AA Shah","year":"2010","journal-title":"J Am Coll Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1055\/s-0031-1275167","article-title":"Review of Chest Wall Tumors: A Diagnostic, Therapeutic, and Reconstructive Challenge","volume":"25","author":"E David","year":"2011","journal-title":"Semin Plast Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/s0003-4975(97)01003-5","article-title":"Mediastinitis After Cardiovascular Operations: A Case-Control Study of Risk Factors","volume":"65","author":"CY Bitkover","year":"1998","journal-title":"Ann Thorac Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2004","DOI":"10.1016\/s0003-4975(00)01814-2","article-title":"Mediastinitis and long-term survival after coronary artery bypass graft surgery","volume":"70","author":"JH Braxton","year":"2000","journal-title":"Ann Thorac Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/1749-8090-2-23","article-title":"Risk factors for mediastinitis after cardiac surgery \u2013 a retrospective analysis of 1700 patients","volume":"2","author":"C Diez","year":"2007","journal-title":"J Cardiothorac Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1055\/s-0035-1551676","article-title":"Cardiac surgery in Germany during 2014: A report on behalf of the German Society for Thoracic and Cardiovascular Surgery","volume":"63","author":"A Beckmann","year":"2015","journal-title":"Thorac Cardiovasc Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1055\/s-0038-1676131","article-title":"German Heart Surgery Report 2018: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery","volume":"66","author":"A Beckmann","year":"2018","journal-title":"Thorac Cardiovasc Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1007\/s00104-013-2678-6","article-title":"Sternumosteomyelitis: \u00c4tiologie, Diagnostik und operative Therapiekonzepte","volume":"85","author":"J Hauser","year":"2014","journal-title":"Chirurg"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1097\/PRS.0b013e3181a205f9","article-title":"Immediate versus delayed one-stage sternal d\u00e9bridement and pectoralis muscle flap reconstruction of deep sternal wound infections","volume":"123","author":"EB Cabbabe","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1097\/SAP.0b013e318284084b","article-title":"The importance of early flap coverage in deep sternal wounds","volume":"73","author":"S Lo","year":"2014","journal-title":"Ann Plast Surg"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.21037\/ccts.2019.12.05","article-title":"Flap reconstruction of the chest wall after oncologic resection","author":"J Salo","year":"2020","journal-title":"CCTS"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1097\/PRS.0b013e318199f49f","article-title":"Sternal osteomyelitis: Long-term results after pectoralis muscle flap reconstruction","volume":"123","author":"A Daigeler","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1016\/j.jtcvs.2006.05.063","article-title":"Simultaneous heart valve replacement and reconstruction of the radiation-damaged chest wall with a delayed vertical rectus abdominis myocutaneous flap","volume":"132","author":"T Strecker","year":"2006","journal-title":"J Thorac Cardiovasc Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1186\/s12893-019-0631-4","article-title":"Deep sternal wound infection \u2013 latissimus dorsi flap is a reliable option for reconstruction of the thoracic wall","volume":"19","author":"N Spindler","year":"2019","journal-title":"BMC Surg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1002\/micr.22405","article-title":"Combined free flaps with arteriovenous loops for reconstruction of extensive thoracic defects after sternal osteomyelitis","volume":"36","author":"CD Taeger","year":"2016","journal-title":"Microsurgery"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000006391","article-title":"Management of the extensive thoracic defects after deep sternal wound infection with the rectus abdominis myocutaneous flap: A retrospective case series","volume":"96","author":"YH Li","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1924","DOI":"10.1097\/00006534-200112000-00012","article-title":"The role of microsurgery in reconstruction of oncologic chest wall defects","volume":"108","author":"PG Cordeiro","year":"2001","journal-title":"Plast Reconstr Surg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1016\/j.jtcvs.2010.05.019","article-title":"Arteriovenous loops in microsurgical free tissue transfer in reconstruction of central sternal defects","volume":"140","author":"MA Reichenberger","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1002\/micr.30730","article-title":"Comparison of pedicled versus free flaps for reconstruction of extensive deep sternal wound defects following cardiac surgery","volume":"41","author":"F Falkner","year":"2021","journal-title":"Microsurgery"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"427","DOI":"10.3390\/jpm12030427","article-title":"The Free Myocutaneous Tensor Fasciae Latae Flap \u2013 A Workhorse Flap for Sternal Defect Reconstruction: A Single-Center Experience","volume":"12","author":"AK Bigdeli","year":"2022","journal-title":"J Pers Med"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000005722","article-title":"Free Flap Reconstruction of Sternal Defects after Cardiac Surgery: An Algorithmic Approach for Dealing with Sparse Recipient Vessels","volume":"12","author":"AK Bigdeli","year":"2024","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1002\/micr.31212","article-title":"The free vastus lateralis-And conjoined vastus lateralis anterolateral thigh\/tensor fascia lata flap for oncological chest wall reconstruction","volume":"44","author":"F Falkner","year":"2024","journal-title":"Microsurgery"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1016\/0003-4975(95)00428-n","article-title":"Free latissimus dorsi flap for chest wall repair after complete resection of infected sternum","volume":"60","author":"A Banic","year":"1995","journal-title":"Ann Thorac Surg"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"E366","DOI":"10.1532\/HSF98.20071079","article-title":"Sternal wound infections following cardiac surgery: Risk factor analysis and interdisciplinary treatment","volume":"10","author":"T Strecker","year":"2007","journal-title":"Heart Surg Forum"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1097\/PRS.0b013e318199f49f","article-title":"Sternal osteomyelitis: Long-term results after pectoralis muscle flap reconstruction","volume":"123","author":"A Daigeler","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1055\/s-2007-1000088","article-title":"Use of free-tissue transfer the treatment of median sternotomy: retrospective review","volume":"15","author":"RE Brown","year":"1999","journal-title":"J Reconstr Microsurg"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1097\/PRS.0b013e3181ef679c","article-title":"Anterolateral thigh free flap for complex composite central chest wall defect reconstruction with extrathoracic microvascular anastomoses","volume":"126","author":"M Di Candia","year":"2010","journal-title":"Plast Reconstr Surg"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1002\/micr.20391","article-title":"An innovative treatment concept for free flap reconstruction of complex central chest wall defects -- the cephalic-thoraco-acromial (CTA) loop","volume":"27","author":"H Engel","year":"2007","journal-title":"Microsurgery"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1055\/s-0036-1578815","article-title":"Arteriovenous Loop-Independent Free Flap Reconstruction of Sternal Defects after Cardiac Surgery","volume":"32","author":"U Dornseifer","year":"2016","journal-title":"J Reconstr Microsurg"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"21809","DOI":"10.1038\/s41598-020-78905-y","article-title":"A multivariable miRNA signature delineates the systemic hemodynamic impact of arteriovenous shunt placement in a pilot study","volume":"10","author":"D Henn","year":"2020","journal-title":"Sci Rep"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"489e","DOI":"10.1097\/PRS.0000000000004750","article-title":"Micro-RNA-Regulated Proangiogenic Signaling in Arteriovenous Loops in Patients with Combined Vascular and Soft-Tissue Reconstructions: Revisiting the Nutrient Flap Concept","volume":"142","author":"D Henn","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1055\/s-0031-1275169","article-title":"Stabilization of the Chest Wall: Autologous and Alloplastic Reconstructions","volume":"25","author":"R Mahabir","year":"2011","journal-title":"Semin Plast Surg"}],"container-title":["Zentralblatt f\u00fcr Chirurgie - Zeitschrift f\u00fcr Allgemeine, Viszeral-, Thorax- und Gef\u00e4\u00dfchirurgie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2637-5118.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T23:45:40Z","timestamp":1764027940000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2637-5118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,21]]},"references-count":32,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2025,11,24]]},"published-print":{"date-parts":[[2025,12]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2637-5118","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0044-409X","1438-9592"],"issn-type":[{"type":"print","value":"0044-409X"},{"type":"electronic","value":"1438-9592"}],"subject":[],"published":{"date-parts":[[2025,7,21]]}}}