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Prinzipien der operativen Behandlung bei schwerer Extremitätenverletzung

Principles of surgical treatment of the mangled extremity

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Zusammenfassung

Schwere Verletzungen der Extremitäten entstehen durch hohe Energieeinwirkung und sind charakterisiert durch die Kombination aus komplexer Fraktur und ausgedehntem Weichteilschaden. Der drohende Verlust der betroffenen Gliedmaße kann mit einer vitalen Bedrohung des gesamten Organismus einhergehen, ungeachtet dessen, ob die Verletzung als Monotrauma oder im Rahmen von Mehrfachverletzungen auftritt. Dank der enormen Fortschritte in der prä- und innerklinischen Versorgung in den letzten Jahrzehnten überleben heute mehr Patienten ihre schweren Unfälle mit hochgradigen Extremitätenverletzungen als in der Vergangenheit. Der vorliegende Beitrag soll dem Leser einen Überblick über die chirurgischen Behandlungsprinzipien komplexer Extremitätenverletzungen verschaffen und die Prinzipien zur Entscheidungsfindung Gliedmaßenerhalt vs. Amputation umreißen. Er basiert auf eine Literaturrecherche in Pubmed und beinhaltet Fallbeispiele aus dem praktischen Alltag der Autoren.

Abstract

Severe injuries of the extremities are caused by high-energy trauma and are characterized by a combination of complex fractures with extensive damage of soft tissues and neurovascular structures. The potential loss of the affected limb can be associated with a life-threatening emergency for the patient irrespective of whether the injury occurs as a monotrauma or as part of multiple injuries. Substantial improvements in preclinical and inhospital treatment over the last decades reduced mortality in severe trauma meaning that more patients survive high-grade extremity injuries than in the past. This article provides the reader with an overview of the current principles of the surgical treatment of complex limb injuries and the principles of the decision-making process in limb salvage surgery versus amputation are outlined. The article is based on a literature search in PubMed and includes examples from the practical daily routine of the authors.

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Authors and Affiliations

  1. Unfall- und Wiederherstellungschirurgie, Chirurgisches Klinikum München Süd, Am Isarkanal 30, 81379, München, Deutschland

    R. Rauf

  2. Klinik und Poliklinik für Unfallchirurgie, Klinikum Rechts der Isar, TU München, München, Deutschland

    S. Pesch & S. Huber-Wagner

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  1. R. Rauf
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  2. S. Pesch
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  3. S. Huber-Wagner
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Correspondence to R. Rauf.

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R. Rauf, S. Pesch und S. Huber-Wagner geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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T. Helfen, München

S. Huber-Wagner, München

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Rauf, R., Pesch, S. & Huber-Wagner, S. Prinzipien der operativen Behandlung bei schwerer Extremitätenverletzung. Notfall Rettungsmed 23, 429–434 (2020). https://doi.org/10.1007/s10049-019-00636-z

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