Zusammenfassung
Bei akuten oder chronischen Knocheninfektionen mit begleitender Weichteilbeteiligung ist der momentane Goldstandard das radikale chirurgische Débridement inklusive der Ausbau infizierter Prothesen. Eine systemische Antibiose entsprechend dem Antibiogramm wird angeschlossen. Oftmals sind mehrere Revisionsoperationen notwendig, um eine Ausheilung zu erreichen. Die Anwendung lokaler Antibiotika bzw. antibiotikahaltiger Materialien ist in der Knochenchirurgie üblich. Neben den üblichen Verfahren, die von der Industrie angeboten und propagiert werden, haben wir bei 21 Patienten die lokale Antibiotikaapplikation in Kombination mit einer Fibrinkleberbesprühung durchgeführt und diese ausgewertet. Acht der 9 Wunden mit Knochenbeteiligung im Bereich der unteren Extremität konnten zur Ausheilung gebracht werden. Von den besonders komplexen Wunden des Beckens waren wir in 2 von 3 Fällen erfolgreich. Problematisch zeigten sich – wie zu vermuten – die Protheseninfekte. Von den 7 desolaten Fällen konnten lediglich 2 Fälle dauerhaft zur Ausheilung gebracht werden. Inzwischen wenden wir die beschriebene Methode für solche speziellen desaströsen Infektsituationen regelmäßig an. Dies erfolgt jedoch nur in Kombination mit den etablierten chirurgischen Verfahren der septischen Chirurgie und dem antiinfektiven Management.
Abstract
In acute and chronic bone infections with concomitant soft tissue involvement the current gold standard is radical surgical debridement including explantation of the infected prosthetic devices. This is followed by initiation of systemic antibiotic therapy appropriate for the antibiogram. Several revision operations are often necessary to achieve complete healing. Additional treatment with local antibiotics or antibiotic-containing substances is routinely used in bone surgery. Apart from the typical procedures with commercially available products, we have conducted a study with 21 patients by application of local antibiotic treatment in combination with the fibrin glue spray technique and evaluated the results. Out of nine wounds of the lower extremities with bone involvement, total healing could be achieved in eight cases. We were also successful in two out of three very complex pelvic wounds; however, as expected the implant infections were complicated. Out of the seven desolate cases we were only able to achieve complete long-term healing in two cases. In the meantime we routinely use the described method in such special disastrous infection situations; however, this is carried out only in combination with established surgical procedures in sepsis surgery and anti-infection management.
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M. Janko, C. Nau, I. Marzi und J. Frank geben an, dass kein Interessenkonflikt besteht.
Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.
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Janko, M., Nau, C., Marzi, I. et al. Lokale Antibiotikafixation durch Fibrinbesprühung. Chirurg 88, 166–174 (2017). https://doi.org/10.1007/s00104-016-0320-0
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DOI: https://doi.org/10.1007/s00104-016-0320-0