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Bedeutung und Prävention postoperativer Wundkomplikationen

Significance and prevention of post-operative wound complications

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Zusammenfassung

Obwohl postoperative Wundinfektionen in der Dermatologie äußerst selten sind, müssen Ursachen und Risiken gut verstanden sein, um eine entsprechende Risikobewertung mit gezielter Infektprävention vornehmen zu können. Wundinfektionen verursachen häufig einen komplizierten, langwierigen und teuren Heilungsverlauf. Typische Erreger sind neben diversen multiresistenten Keimen Staphylococcus aureus, Staphylococcus epidermidis, hämolysierende Streptokokken und die Gram-negativen Stäbchen Escherichia coli und Pseudomonas aeruginosa. Ein funktionierendes Hygieneregime im Rahmen eines adäquaten Qualitätsmanagements gerade auch in der dermatologischen Praxis sollte die kritischen Punkte der Infektiogenese abdecken: Vorbereitung des Operationsfeldes, präoperative Hautdesinfektion, Händehygiene, sichere chirurgische Technik und Barrieremaßnahmen zum Schutz vor Erregerverbreitung. Die Basisinfektionsrate nach dermatochirurgischen Eingriffen ist niedrig, kann jedoch von der Implementierung risikoadaptierter Präventionsmaßnahmen profitieren.

Abstract

Although surgical site infections (SSI) in dermatologic operative procedures are extremely rare, it is important to understand risks and etiological factors to initiate risk assessment and specific preventive measures. SSI commonly are associated with a complicated, long-term and expensive outcome. Typical wound pathogens of these infections include a variety of multiresistant organisms along with Staphylococcus aureus, Staphylococcus epidermidis, hemolytic streptococci and the gram-negative bacilli Escherichia coli and Pseudomonas aeruginosa. Effective hygienic measures as part of an adequate quality management system should consider the critical points in the development of SSI, particularly in the setting of an outpatient dermatologic unit, such as preparation of the operative area, preoperative skin antisepsis, hand hygiene, safe and skilled technique by surgeons, and barrier nursing to prevent spread of pathogens. The baseline infection incidence in dermatologic surgery inherently is low; nevertheless significant improvements can be achieved by implementation of risk-adapted infection control measures.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Napp, D. Gümbel, J. Lange, P. Hinz, G. Daeschlein und A. Ekkernkamp geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik und Poliklinik für Chirurgie, Abteilung für Unfall- und Wiederherstellungschirurgie, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-Universität Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland

    M. Napp, D. Gümbel, J. Lange, P. Hinz & A. Ekkernkamp

  2. Unfallkrankenhaus Berlin, Berlin, Deutschland

    D. Gümbel & A. Ekkernkamp

  3. Klinik und Poliklinik für Hautkrankheiten, Universitätsmedizin Greifswald, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Deutschland

    G. Daeschlein

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  1. M. Napp
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  2. D. Gümbel
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  3. J. Lange
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  4. P. Hinz
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  5. G. Daeschlein
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  6. A. Ekkernkamp
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Correspondence to M. Napp.

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Napp, M., Gümbel, D., Lange, J. et al. Bedeutung und Prävention postoperativer Wundkomplikationen. Hautarzt 65, 26–31 (2014). https://doi.org/10.1007/s00105-013-2633-y

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  • DOI: https://doi.org/10.1007/s00105-013-2633-y

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