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Rekonstruktion der unteren Extremität im Alter – ein interdisziplinärer Ansatz

Geriatrisches Assessment, perioperatives Management, Diagnostik und Therapieziele

Reconstruction of lower limbs in old age—an interdisciplinary approach

Geriatric assessment, perioperative management, diagnostics and treatment targets

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Zusammenfassung

Verletzungen der unteren Extremität bei multimorbiden und geriatrischen Patienten stellen eine zunehmende Herausforderung dar, wobei ein interdisziplinäres Setting für den Erfolg der Therapie erforderlich ist. Ziel der interdisziplinären Therapie ist die funktionelle Extremitätenrekonstruktion durch knöcherne Rekonstruktion, Revaskularisation und Defektdeckung mit Erhalt der Mobilität sowie der möglichst schnellen Rückkehr ins gewohnte Umfeld und Vermeidung morbiditäts- und mortalitätsbehafteter Major-Amputationen. Die Dystrophie des Haut-Weichteil-Mantels gepaart mit kardiovaskulären Risikofaktoren und metabolischen Erkrankungen erfordert sowohl das geriatrische und diagnostische Assessment als auch die therapeutische Zusammenarbeit durch Vertreter verschiedener Disziplinen. Perioperativ ist ein multidisziplinäres Vorgehen unter Verbesserung aller optimierbaren Risikofaktoren im Rahmen der spezialisierten interdisziplinären Therapieplanung („Extremitätenboard“ eines spezialisierten Zentrums) zwingende Voraussetzung für den Behandlungserfolg. Es soll eine Übersicht über die Besonderheiten des geriatrischen Assessments, die Diagnostik, das perioperative Management und die Therapieziele gegeben werden.

Abstract

Complex injuries of the lower extremities in geriatric patients with multiple pre-existing comorbidities represent an increasing challenge to an interdisciplinary team of surgeons. Functional reconstruction of the extremity through osteosynthesis, revascularization and defect coverage aims to preserve mobility and achieve an early return to activities of daily life at home, while avoiding major amputation and the associated risks regarding morbidity and mortality. An interdisciplinary assessment of geriatric patients regarding dystrophy of soft tissue and skín, cardiovascular and metabolic comorbidities as well as specific geriatric diagnostics are crucial steps in ensuring favorable outcomes. Perioperatively, all improvable risk factors should be actively optimized and a specialized interdisciplinary approach to treatment planning (extremity board) is absolutely necessary for success of treatment. It outlines the special features of the geriatric assessment, diagnostics, perioperative management and treatment targets.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädie, Sektion für Septische Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, Ludwigshafen, Deutschland

    G. Reiter, F. Weil & P. A. Grützner

  2. Klinik für Hand, Plastische und Rekonstruktive Chirurgie, – Schwerbrandverletztenzentrum – BG Unfallklinik Ludwigshafen; Klinik für Plastische und Handchirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland

    B. Thomas & U. Kneser

  3. Klinik für Gefäßchirurgie, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Deutschland

    C. Kühner & A. Schäfer

  4. Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, BG Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland

    G. Wittenberg

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  1. G. Reiter
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  2. F. Weil
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  3. B. Thomas
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  4. C. Kühner
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  5. G. Wittenberg
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  7. P. A. Grützner
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  8. U. Kneser
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Correspondence to G. Reiter.

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Interessenkonflikt

G. Reiter, F. Weil, B. Thomas, C. Kühner, G. Wittenberg, A. Schäfer, P.A. Grützner und U. Kneser 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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Reiter, G., Weil, F., Thomas, B. et al. Rekonstruktion der unteren Extremität im Alter – ein interdisziplinärer Ansatz. Chirurg 90, 795–805 (2019). https://doi.org/10.1007/s00104-019-01022-8

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