Die aktuelle S3-Leitlinie zur Prophylaxe der venösen Thromboembolie und ihre Implikation für die Plastische Chirurgie

Zusammenfassung

Evidenzbasierte Leitlinien zur perioperativen Thromboembolieprophylaxe in der Plastischen Chirurgie existieren in Deutschland bislang nicht. Die zunehmende Komplexität mikrochirurgisch-rekonstruktiver Eingriffe und der technische Fortschritt in der Medizin machen die Formulierung einer evidenzbasierten Leitlinie zu diesem Thema jedoch erforderlich, zumalältere Patienten mit Komorbiditäten und hieraus resultierendem erhöhten Thromboembolierisiko zunehmend das Patientengut in der Plastischen Chirurgie widerspiegeln. Aus diesem Grund haben wir die aktuelle S3-Leitlinie zur venösen Thromboembolieprophylaxe der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) mit Stand vom April 2009 auf ihre Relevanz für die plastische Chirurgie geprüft und in körperregionsbezogene Eingriffe unterteilt.

Abstract

Introduction: In Germany, clinically and experimentally proven, evidence-based guidelines for the perioperative prophylaxis of thromboembolism in plastic surgery have not yet been developed. The ever-expanding complexity of microsurgical reconstructive procedures associated with the immense technical progress in the medical field have once more highlighted the urgent need for evidence-based guidelines. Moreover, this urgency is underlined by more and more complex reconstructive procedures needing to be performed in elderly patients presenting with grave comorbidities and the related high risk for thromboembolic events. These facts prompted us to review and discuss the relevance of the updated S3-guidelines on prophylaxis of venous thromboembolic events for the field of plastic and reconstructive surgery[41].

Material and Methods: The existing S3-guidelines represent the result of a consensus between 27 medical societies and organisations. Delegates of the German Society of Plastic, Reconstructive and Aesthetic Surgery (DGPRAEC) also participated in this consensus process and the development of the guidelines, which provide evidence-based and clinically oriented recommendations for the prophylaxis of venous thromboembolism for operative and non-operative as well as outpatient and inpatient settings. In the results section of this paper, general and specific recommendations with regard to plastic and reconstructive surgery are outlined.

Results: Indications for the pharmacological prophylaxis of thromboembolic events are oriented on the specific risk categories for surgical interventions with regard to the dispositional individual risk factors. Furthermore, the recommendations for the field of plastic and reconstructive surgery are subdivided into the various regions of the body.

Discussion: Evidence-based recommendations for perioperative prophylaxis of venous thromboembolism in plastic surgery are not available yet. The establishment of an algorithm to screen and estimate the procedure-associated risks for thromboembolism is needed. The discussed S3-guidelines of the AWMF Society on the prophylaxis of venous thromboembolism meet these formal requirements. Gathering of evidence-based data and the generation of recommendations leading to a reduction of the perioperative risk of thromboembolic events is a pivotal element to improve patient outcomes and safety in microsurgery.

Heparin - Antikoagulation - Thrombose - Thromboembolie - Plastische Chirurgie

heparin - anticoagulation - thrombosis - thromboembolism - plastic surgery

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