Weichteilmanagement bei komplexem Fußtrauma

Zusammenfassung

Das komplexe Fußtrauma ist selten und meist durch einen schweren Weichteilschaden gekennzeichnet. Hinzu kommen höhergradige knöcherne und neurovaskuläre Verletzungen sowie Gelenkbeteiligungen. Frühzeitig steht eine Entscheidung zwischen einer primären Amputation und Rekonstruktion in Vordergrund, in der Initialphase muss zwischen einer direkten definitiven Therapie und einem mehrzeitigen Vorgehen gewählt werden. Meist ist ein mehrzeitiges, interdisziplinäres Therapieregime erforderlich. Oberstes Ziel ist die Verhinderung des Fortschreitens der Ischämie mit Gewebeuntergang, Nekrose und Infektion. Operative Prinzipien beinhalten regelmäßige Débridements, frühzeitige plastische Weichteilrekonstruktionen und knöcherne Stabilisierungen meist durch externe Fixationen. Die knöcherne Rekonstruktion erfolgt von proximal nach distal mit anatomischer Rekonstruktion der Fußsäulen und stabiler innerer Fixierung.

Abstract

The complex foot trauma is rare and usually characterized by severe soft tissue damage. In addition, there are high-grade bony and neurovascular injuries as well as joint involvement. At early stage, a decision between primary amputation and reconstruction is in the foreground; in the initial phase, a choice must be made between a direct definitive therapy and a multi-stage approach. A multi-stage, interdisciplinary therapy regimen is usually required. The primary goal is to prevent the progression of ischemia with tissue destruction, necrosis and infection. Operational principles include regular debridements, early plastic soft tissue reconstruction and osseous stabilization, mostly through external fixations. The bony reconstruction is carried out from proximal to distal with anatomical reconstruction of a plantigrade foot and stable internal fixation.

Schlüsselwörter

Fußtrauma - Komplex - Weichteilschaden - Amputation

Key words

foot trauma - complex - mangled foot - soft tissue

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