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Die komplexe Handverletzung

Indikationen für freie mikrovaskuläre Lappentransplantate

Complex hand injuries

Indications for free microvascular flap reconstruction

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Das Spektrum von Handverletzungen reicht von Bagatellschäden bis hin zu komplexen Traumata mit gleichzeitigem Verlust mehrerer funktioneller Gewebe. Je nach Schweregrad und Genese verlangen alle Verletzungen ein an das Patientenprofil adaptiertes Vorgehen zur Rekonstruktion. Bei Vorhaltung entsprechender operativer und logistischer Bedingungen muss das gesamte Spektrum rekonstruktiver Möglichkeiten für ein optimales Ergebnis ausgeschöpft werden, wobei spezielle Algorithmen bei der Entscheidungsfindung helfen.

Patienten und Methoden

Mehrere komplexe Handverletzungen und die plastisch-chirurgischen Therapieprinzipien mit freien Lappen werden vorgestellt.

Ergebnisse

Freie Lappen ermöglichen die sichere, auch simultane Rekonstruktion mehrerer funktioneller Gewebe nach komplexen Handverletzungen und reduzieren bei richtiger Indikation die Morbidität erheblich.

Schlussfolgerung

Freie, revaskularisierte Gewebetransfers fließen für ein optimales Ergebnis schon früh in die rekonstruktiven Algorithmen der Therapieplanung ein und repräsentieren nicht länger eine „Ultima-ratio-Option“.

Abstract

Background

Hand injuries range from minor lacerations to severe, complex injuries with accompanying loss of functional structures and various tissues. Depending on the severity and mechanism, all injuries require a reconstructive plan adapted to the patient profile. In plastic-surgery centers with adequate operative and logistic experience, the full range of the “reconstructive ladder” must be used, while algorithms help in decision making in the treatment plan.

Patients and methods

Several complex hand injuries and their plastic-surgical therapy with microvascular flaps are presented.

Results

Free flaps allow a safe and simultaneous reconstruction of functional tissues after complex hand injuries and significantly reduce morbidity.

Conclusion

For optimal results, free microvascular tissue transfers are considered early in the reconstructive treatment plan and no longer represent a final treatment option.

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Correspondence to G. A. Giessler.

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Giessler, G.A., Germann, G. Die komplexe Handverletzung. Trauma Berufskrankh 6, 101–107 (2004). https://doi.org/10.1007/s10039-004-0873-x

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  • DOI: https://doi.org/10.1007/s10039-004-0873-x

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