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Plastische Rekonstruktionsverfahren der Brustwand nach Mediastinitis

Surgical reconstructive procedures of the chest wall after mediastinitis

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Zusammenfassung

Die Sternumosteomyelitis als direkte Folge einer fortgeschrittenen Mediastinitis oder in den meisten Fällen nach medianer Sternotomie ist weiterhin mit einem verlängerten Krankenhausaufenthalt sowie einer erhöhten Morbidität und postoperativen Letalität assoziiert. Die frühzeitige Diagnose und eine adäquate chirurgische Therapie bestimmen die Prognose. Grundvoraussetzung für eine sekundäre Stabilisierung des Sternums mittels Reverdrahtung oder Plattenosteosynthese sind saubere Wundverhältnisse. Abhängig von der Größe und Lokalisation des Defektes stehen unterschiedliche Stabilisierungs- und plastische Rekonstruktionsverfahren der Brustwand zur Verfügung. In diesem Übersichtsartikel werden auch die unterschiedlichen lokalen und freien Gewebeplastiken zur sternalen Defektdeckung beschrieben.

Abstract

Sternal osteomyelitis as a direct consequence of advanced mediastinitis or as in most cases after median sternotomy is still associated with a prolonged hospital stay, increased morbidity and postoperative mortality. Early diagnosis and an adequate surgical treatment are decisive for the prognosis. Prerequisites for a secondary stabilization of the chest wall using wires or plates are sterile wound conditions. Diverse reconstructive techniques are available for anterior chest wall reconstruction depending on the defect size and localization. The various reconstructive methods including local and free flap coverage are described in this review article.

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Authors and Affiliations

  1. Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland

    M. Ried, T. Potzger, R. Neu & H. S. Hofmann

  2. Zentrum für Plastische, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    S. Geis, S. Klein, L. Prantl & J. H. Dolderer

  3. Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland

    H. S. Hofmann

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  1. M. Ried
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  2. S. Geis
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  3. T. Potzger
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  4. R. Neu
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  5. S. Klein
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  6. L. Prantl
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  7. H. S. Hofmann
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  8. J. H. Dolderer
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Correspondence to M. Ried.

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Interessenkonflikt

M. Ried, S. Geis, T. Potzger, R. Neu, S. Klein, L. Prantl, H.S. Hofmann und J.H. Dolderer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Die Autoren M. Ried und S. Geis haben zu gleichen Teilen zu der Arbeit beigetragen.

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Ried, M., Geis, S., Potzger, T. et al. Plastische Rekonstruktionsverfahren der Brustwand nach Mediastinitis. Chirurg 87, 489–496 (2016). https://doi.org/10.1007/s00104-016-0173-6

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  • DOI: https://doi.org/10.1007/s00104-016-0173-6

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