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Der Chirurg

, Volume 87, Issue 6, pp 537–550 | Cite as

Sternumosteomyelitis – chirurgische Behandlungskonzepte

  • J. P. Beier
  • A. Arkudas
  • W. Lang
  • M. Weyand
  • R. E. Horch
CME

Zusammenfassung

Die Sternumosteomyelitis ist ein v. a. nach kardiochirurgischen Eingriffen auftretendes Krankheitsbild mit u. U. hoher Letalität. Nach möglichst frühzeitiger Diagnosestellung sollte zunächst ein interdisziplinäres ausreichend radikales Débridement erfolgen. Im Verlauf ist in der Regel eine plastisch-rekonstruktive Defektdeckung erforderlich. Hierfür steht eine Reihe gestielter und freier Lappenplastiken zur Verfügung, die je nach Defektgröße und individueller Voraussetzungen des Patienten an den potenziellen Lappenentnahmestellen Anwendung finden. Kleinere Defekte können oft mit gestielten Lappenplastiken rekonstruiert werden. Bei sehr ausgedehnten Defekten ist inzwischen die Defektdeckung mittels einer einzelnen freien mikrochirurgischen Lappenplastik, ggf. mit Anlage einer arteriovenösen Gefäßschleife, als mindestens gleichwertig einzuschätzendes Verfahren etabliert. Die erfolgreiche Therapie der Sternumosteomyelitis basiert somit auf einer frühzeitigen interdisziplinären Zusammenarbeit aller beteiligten Fachdisziplinen.

Schlüsselwörter

Débridement Herzchirurgie Mediane Sternotomie Gestielte Lappenplastik Freie mikrochirurgische Lappenplastik 

Sternal osteomyelitis – Surgical treatment concepts

Abstract

Sternal osteomyelitis is a potentially fatal condition following cardiac surgery. Sternal osteomyelitis should be diagnosed as early as possible followed by an interdisciplinary radical debridement. Subsequently plastic reconstructive surgery is necessary for defect reconstruction. This can be achieved by a number of established pedicled and free flap plastic surgery procedures. The choice of flap procedures is based on defect geometry and the individual patient situation, including potential flap donor sites. Smaller defects can generally be reconstructed by pedicled flap transfer. For extensive sternal defects, free flap transplantation is now a well-established therapeutic option. In some patients lacking sufficient recipient vessels, the creation of an arteriovenous (AV) loop as recipient vessel is necessary. In summary, successful therapy of sternal osteomyelitis is based on early interdisciplinary treatment by the various surgical subspecialties.

Keywords

Debridement Cardiac surgical procedures Median sternotomy Pedicled flaps Microsurgical free flaps 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. P. Beier, A. Arkudas, W. Lang, M. Weyand und R. E. Horch geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • J. P. Beier
    • 1
  • A. Arkudas
    • 1
  • W. Lang
    • 2
  • M. Weyand
    • 3
  • R. E. Horch
    • 1
  1. 1.Plastisch- und Handchirurgische KlinikUniversitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)ErlangenDeutschland
  2. 2.Gefäßchirurgische AbteilungUniversitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)ErlangenDeutschland
  3. 3.Herzchirurgische KlinikUniversitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)ErlangenDeutschland

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