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Handchir Mikrochir Plast Chir 2021; 53(06): 519-525
DOI: 10.1055/a-1425-5987
Consensus Statement

Der tiefe sternale Wundinfekt nach Sternotomie

Konsensus-Bericht der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der peripheren Nerven und Gefäße (DAM)Deep sternal wound infection after sternotomyReport of the consensus workshop of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels (DAM)
Yves Harder‡
1   Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Ospedale Regionale di Lugano (ORL), Ente Ospedaliero Cantonale (EOC), Lugano, Schweiz
2   Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Schweiz
,
Johanna Krapf‡
3   Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Medizinische Universität Innsbruck, Österreich
,
Bernd Rieck
4   Kaiser-Friedrich-Straße, Hildesheim, Deutschland
,
Dirk J. Schaefer
5   Klinik für Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel, Schweiz
,
Gabriel Djedovic
6   Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Landekrankenhaus Feldkirch, Österreich
,
Ingo Kutschka
7   Klinik für Thorax-, Herz- und Gefäßchirurgie, Universitätsmedizin Göttingen, Deutschland
,
Karolin Graf
8   Zentralinstitut für Krankenhaushygiene, Paracelsus- Kliniken Deutschland, Langenhagen, Deutschland
,
Ulrich Kneser
9   Klinik für Hand-, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Klinik für Plastische und Handchirurgie, Universität Heidelberg, Deutschland
,
Raymund E. Horch 
10   Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Deutschland
,
Marcus Lehnhardt
11   Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, BG Universitätsklinikum Bergmannsheil Bochum, Deutschland
,
Gerhard Pierer
3   Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Medizinische Universität Innsbruck, Österreich
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Zusammenfassung

Der tiefe sternale Wundinfekt (TSWI) ist eine seltene Komplikation nach Sternotomie, die mit hoher Morbidität und Mortalität behaftet ist und Krankenhausaufenthalt sowie die Behandlungskosten signifikant ansteigen lässt. Eine mikrobiologische Besonderheit ist die Ausbildung von Biofilmen auf Implantatmaterial und/oder Knochensequestern. Die Diagnose wird anhand der klinischen Symptomatik der lokalen Entzündungsreaktion gestellt und durch systemische Infektionszeichen gestützt. Eine frühzeitige und gemeinsame Konsensfindung, welche die oft interdisziplinäre Behandlungsstrategie festlegt, ist dabei essenziell. Die Behandlung besteht i. d. R. aus mehreren chirurgischen Wunddebridements mit zwischenzeitlicher Wundkonditionierung, bis ein ausreichend sauberer Wundstatus erreicht ist. Zur Infektsanierung und für den Wundverschluss stehen je nach Größe und Lokalisation des Gewebedefektes eine Vielzahl verschiedener gestielter und freier Lappenplastiken zur Auswahl.

Abstract

Deep sternal wound infection (TSWI) is a potentially life-threatening complication that may occur after median sternotomy, contributing to prolonged hospital stay and increased health care costs. Bacterial infection is often characterized by biofilm formation on implant material and/or dead bone. Diagnosis is made upon clinical signs and symptoms of local and systemic infection. Early multidisciplinary decision making is needed for optimal patient care. Repeated surgical wound debridements accompanied by wound conditioning are performed until clean circumstances are achieved. Thereafter, wound closure and defect reconstruction are obtained using a variety of pedicled and microvascular flaps.

Schlüsselwörter

Gestielte Lappenplastiken - freie Lappenplastiken - Infektion - Sternum

Key words

Pedicled flaps - free flaps - infection - Sternum


Publication History

Received: 13 January 2021

Accepted: 01 March 2021

Article published online:
05 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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