Postoperatives Drainage- und Wundmanagement nach Wirbelsäuleneingriffen

Zusammenfassung

Chirurgische Eingriffe sind mittlerweile etablierte Behandlungsoptionen für eine Reihe von Pathologien der Wirbelsäulen. Vor allem in der in den letzten Jahrzehnten hat die Zahl der Operationen in diesem Bereich erheblich zugenommen und damit die Anzahl der möglichen perioperativen Komplikationen. Hämatome und Wundheilungsstörungen müssen in diesem Zusammenhang besonders hervorgehoben werden. Der effektivste Weg diese zu vermeiden liegt in der Primärprävention, wobei in diesem Zusammenhang auch die Wahl der postoperativen Wunddrainage und das Wundmanagement diskutiert werden müssen. Die derzeitige Literatur rechtfertigt den routinemäßigen Einsatz von Drainagen bei thorakolumbalen Wirbelsäuleneingriffen nicht und auch die Art des Wundmanagements scheint von untergeordneter Bedeutung zu sein. Hervorzuheben ist lediglich, dass ein ausreichend feuchtes Milieu vorhanden ist. Ebenso sollten frühe und zu häufige Verbandswechsel vermieden werden, um eine Kontamination zu vermeiden. Weitere wichtige Punkte im Zusammenhang mit der Vermeidung postoperativer Wundkomplikationen ist der adäquate chirurgischer Wundverschluss, die schnelle Mobilisierung sowie die korrekte Lagerung des Patienten.

Abstract

Surgical interventions are now established treatment options for a number of spinal pathologies. Especially in the last decades, the number of operations in this area has increased significantly and with it the number of possible perioperative complications. Hematomas and wound complications are particularly noteworthy. The most effective way to avoid them is primary prevention, whereby the choice of wound drainage and appropriate wound management must also be discussed. However, the current literature does not justify the routine use of drains in elective thoracolumbar spine surgery. The rate of postoperative complications appears unchanged. The type of wound dressing is also of secondary importance for the postoperative course, as long as an adequate moisture environment is ensured. Too early and too frequent dressing changes should be avoided to avoid contamination. In addition to adequate surgical wound closure, rapid mobilization and frequent changes in the patient's position appear to be important for reducing postoperative wound complications.

Schlüsselwörter

Wunddrainagen - postoperative Hämatome - Wundinfektionen - Wirbelsäulenchirurgie - Wundmanagement

Keywords

Wound drains - Postoperative haematoma - Wound infection - Spinal surgery - Wound management

Publication History

Article published online:
26 August 2022

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