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Weichteilmanagement offener Frakturen

Update 2016

Soft tissue management of open fractures

Update 2016

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Offene Frakturen gehören weiterhin zu den Herausforderungen der Unfallchirurgie und Diskussionen über den am besten geeigneten Therapieansatz sind häufig. Akribisches Weichteilmanagement ist entscheidend, um einen optimalen Heilungsverlauf zu erreichen. Allerdings fehlt vielen üblichen Therapieempfehlungen die Evidenz.

Methoden

Die Autoren führten eine kritische Durchsicht der veröffentlichten Empfehlungen bezüglich des Weichteilmanagements offener Frakturen durch. Die berücksichtigten Studien wurden aufgrund ihrer klinischen Relevanz ausgesucht.

Resultate

Insgesamt wurden 29 Studien eingeschlossen. Das Review berücksichtigte insbesondere das Timing des initialen Débridements, die Zeit bis zum definitiven Wundverschluss, den Nutzen der „negative pressure wound therapy“ (NPWT) und der plastischen Chirurgie sowie die Antibiotikagabe in der Therapie offener Frakturen.

Schlussfolgerung

Für offene Frakturen gilt eine dringliche Operationsindikation. Ein zügiger Wundverschluss in Abhängigkeit von einer vollständigen Resektion allen nekrotischen Gewebes vermindert das Auftreten von Komplikationen. Eine kalkulierte Kurzzeitantibiose ist für die Infektionsprävention essenziell. Letztendlich bleiben die Verfahren der plastischen Chirurgie trotz der Bedeutung der NPWT für die Therapie der mit offenen Frakturen assoziierten Wunden integraler Bestandteil der Strategien für den Gliedmaßenerhalt.

Abstract

Background

Open fractures continue to be a challenge to orthopedic trauma surgeons and controversies with respect to best clinical practice are common. Meticulous management of soft tissue damage is of particular importance to achieve the optimal course; however, many treatment protocols lack evidence-based data.

Methods

The authors performed a critical review of the literature involving recommendations on the management of soft tissue damage in open fractures. Studies were selected based on their relevance to clinical treatment of open fractures.

Results

A total of 29 studies were included. The review focused on timing of initial débridement, time until wound closure, utilitization of negative pressure wound therapy (NPWT), the necessity for plastic surgery and and administration of antibiotics in the therapy of open fractures.

Conclusion

Open fractures require urgent debridement. Timely wound closure dependent on successful removal of all necrotic tissue decreases the rate of complications. A calculated short-term administration of antibiotics is essential to avoid infections. Finally, despite the utmost importance of NPWT in the treatment of wounds associated with open fractures, flap coverage of tissue defects remains an integral component of the limb salvage algorithm.

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Danksagung

Die Autoren danken Frau M. Janke für die Hilfe beim Erstellen der Abbildung.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Zentrum für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Deutschland

    M. Napp, R. Spitzmüller, D. Gümbel & P. Hinz

  2. Unfallkrankenhaus Berlin (ukb), Warener Straße 7, 12683, Berlin, Deutschland

    D. Gümbel

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  1. M. Napp
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  2. R. Spitzmüller
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  4. P. Hinz
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Correspondence to M. Napp.

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Interessenkonflikt

M. Napp, R. Spitzmüller, D. Gümbel und P. Hinz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Napp, M., Spitzmüller, R., Gümbel, D. et al. Weichteilmanagement offener Frakturen. Trauma Berufskrankh 18, 16–21 (2016). https://doi.org/10.1007/s10039-016-0124-y

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