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Autologe Verfahren zur Therapie von Gefäßinfektionen

Autologous procedure for the treatment of vascular infections

Zusammenfassung

Die Entwicklung einer tiefen Infektion nach gefäßrekonstruktiven Eingriffen stellt den Supergau in der Gefäßchirurgie dar und erfordert neben einer klinikabhängigen differenzierten Diagnostik ein situations- und stadiengerechtes gezieltes, frühes und aggressives Vorgehen. Neben der maximalen systemischen und lokalen Infektionsbekämpfung hilft in vielen Fällen die lokale Rekonstruktion unter Verwendung autologen Materials in Kombination mit mittelfristig resorbierbarem Nahtmaterial. Dieses Verfahren wird als autologe Rekonstruktion bezeichnet.

Für alle Infektionslokalisationsbereiche steht eine Palette von autologen Rekonstruktionsverfahren zur Verfügung, um adäquat und effektiv therapieren zu können. Damit wird in den meisten Fällen die Durchblutungssituation gesichert, Zeit gewonnen und das Leben und die Extremität der Patienten erhalten. Höchste Priorität haben die Bekämpfung der Infektion sowie der Erhalt des Lebens und der Extremität des Patienten. Im Stadium der tiefen Infektion ist es bereits als Erfolg anzusehen, wenn der Status quo ante nach Infektionsausheilung wieder erreicht werden kann. Nach entsprechendem zeitlichem Intervall kann dann immer noch wieder unter den Maximen der Gefäßchirurgie reinterveniert werden.

Abstract

The development of a deep infection following vascular reconstructive surgery is the most demanding situation encountered in vascular surgery and requires diagnostic investigations that will vary with the hospital concerned and a targeted, early and aggressive attack on the infection both systemically and locally; in addition, local reconstruction carried out with autologous materials in association with sutures that are absorbed over the medium term – also referred to as autologous reconstruction – is helpful in many cases.

A range of autologous reconstruction procedures is available for application at all sites of infection, allowing adequate and effective treatment. In most cases these can ensure a secure blood flow situation, win time, and keep the patient alive and conserve his or her extremity. The main priority is to combat the infection and make it possible to keep the patient alive and the extremity affected intact. When the stage of deep infection has been reached even recovery of the initial status once the infection is cured can be regarded as a success. After an appropriate time it is always possible to reoperate on the basis of the principles of vascular surgery.

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Zühlke, H. Autologe Verfahren zur Therapie von Gefäßinfektionen. Gefässchirurgie 11, 409–422 (2006). https://doi.org/10.1007/s00772-006-0491-y

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Schlüsselwörter

  • Tiefe Infektion
  • Infektionsbekämpfung
  • Débridement
  • Autologe Rekonstruktionsverfahren

Keywords

  • Deep infection
  • Combating infection
  • Débridement
  • Autogenic reconstructive procedures