Ischämische Kontrakturen an Unterarm und Hand

U. Lanz; J. Felderhoff

doi:10.1055/s-2000-19239

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Handchir Mikrochir Plast Chir 2000; 32(1): 6-25
DOI: 10.1055/s-2000-19239

Übersicht

Georg Thieme Verlag Stuttgart · New York

Ischämische Kontrakturen an Unterarm und Hand

Ischaemic Contractures of the Forearm and HandU. Lanz, J. Felderhoff

Klinik für Handchirurgie, Abteilung I (Chefarzt: Prof. Dr. U. Lanz), Rhön-Klinikum, Bad Neustadt/Saale

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Publication History

Publication Date:
20 December 2001 (online)

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Zusammenfassung

Die Arbeit gibt einen Überblick über die Anatomie, Pathophysiologie, Ätiologie und Diagnose des Kompartment-Syndroms mit den daraus resultierenden ischämischen Muskelnekrosen der oberen Extremität. Auf den Zusammenhang zwischen Kompartment-Syndrom und Infekt wird hingewiesen. Während die Behandlung des manifesten Kompartment-Syndroms durchweg in der operativen Eröffnung der betroffenen Faszienräume besteht, ist die Therapie der ischämischen Muskelnekrose vielfältig. Sie richtet sich nach der Schwere und der Lokalisation des Krankheitsbildes. Nur die mildeste Form kann mit nichtoperativen Maßnahmen angegangen werden. Operativ kommen Neurolyse, Exzision von Nekrosen und Narben, muskel- und sehnenverlängernde Maßnahmen, Sehnentranspositionen, bis hin zur freien mikrovaskulär angeschlossenen Muskeltransplantation in Betracht. Nur wenn alle Behandlungsoptionen zur Verfügung stehen, kann der Chirurg den für den einzelnen Patienten günstigsten Behandlungsweg wählen.

Summary

This article gives an overview of anatomy, pathophysiology, aetiology, and diagnosis of the compartment syndrome and the resulting ischaemic necrosis of the upper extremity. The relation between compartment syndrome and infection is pointed out. Whereas the therapy of a manifest compartment syndrome is rather uniform consisting in decompression of the involved fascial compartment, the treatment of the ischaemic muscle necrosis is manifold. It depends upon severity and location of the disease. Only the mildest involvement can be treated by nonoperative measures. Surgically, neurolysis, excision of necrotic musculature and scar, muscular slide, elongating tenotomy, tendon transposition and free vascularized muscle transplantation have to be considered. Only the availability of all treatment options gives the surgeon the choice of treatment that fits the demands of the individual patient best.

Schlüsselwörter

Kompartment-Syndrom - Ischämische Muskelnekrose - Volkmannsche Kontraktur - Pathophysiologie - Diagnostik - Therapie

Key words

Compartment syndrome - ischaemic muscle necrosis - Volkmann's contracture - pathophysiology - diagnosis - therapy

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Prof. Dr. med. Ulrich Lanz

Klinik für Handchirurgie Abteilung I

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