Zusammenfassung
Als extreme Handverletzungen werden Läsionen bezeichnet, die laut ihrer Prognose nur eine fragwürdige Indikation zur Erhaltung der Hand aufweisen. Amputation und Handprothesenversorgung sind deshalb die bedenkenswerte Alternative zur aufwendigen mikrochirurgischen Rekonstruktion. Alle Möglichkeiten der modernen mikrochirurgischen Rekonstruktion mit normo- oder heterotoper Replantation, mikrochirurgischem mehrschichtigem Gewebetransfer bis hin zu multiplen chimärischen sensibilisierten Lappenplastiken sind notwendig, um derart verletzte Hände sinnvoll erhalten zu können. Des Weiteren bedarf es der adaptierten, hochspezialisierten Handtherapie, die in unmittelbarer Steuerung und Kontrolle durch den Handchirurgen agiert. Der Aufwand ist jedoch nicht nur für die Lebensqualität des Patienten, sondern auch aus volkswirtschaftlicher Sicht besonders für die gesetzliche Unfallversicherung gerechtfertigt.
Abstract
Devastating hand injuries often have a dire and questionable prognosis if the hand is preserved. Therefore amputation and upper extremity prosthesis fitting should always be considered as possible alternatives to a complex microsurgical reconstruction. All possibilities of modern microsurgical reconstructive options including normotopic and heterotopic replantation, multi-component tissue transfer and chimeric sequential free flaps are necessary to preserve form and function of hands that were massively injured. Individualized, highly specialized hand therapy is an integral part of the therapeutic approach, which acts according to the orders and control of the operating hand surgeon. All these enormous efforts are justified in selected cases not only for the patient to regain a certain quality of life, but also from the view of overall economy and statutory health insurance.
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Schmidt, A., Woltmann, A., Baas, N. et al. Management der extremen Handverletzung. Trauma Berufskrankh 13, 97–103 (2011). https://doi.org/10.1007/s10039-011-1721-4
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DOI: https://doi.org/10.1007/s10039-011-1721-4