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Plastisch-chirurgische Defektdeckung beim Dekubitus des Rumpfes und der Beckenregion

Plastic surgery coverage of pressure ulcers of the trunk and pelvic region

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Zusammenfassung

Das Dekubitalulkus entsteht durch Druck auf Gewebe mit entsprechend resultierender Minderperfusion des betroffenen Areals, es entwickelt sich vor allem im Bereich knöcherner Prominenzen. Betroffen sind nicht oder nur eingeschränkt mobile Patienten sowie Menschen mit gestörter Sensibilität. Patienten mit fortgeschrittenem Alter besitzen im Vergleich zu jüngeren Menschen ein deutlich erhöhtes Risiko, häufig liegt bei diesem Patientengut eine Kombination aus weiteren extrinsischen und intrinsischen Risikofaktoren vor. Demnach ist die Prävention und Behandlung dieser komplexen Hautläsionen vor allem auch hinsichtlich des demographischen Wandels eine interdisziplinäre Herausforderung mit hohem sozioökonomischem Stellenwert. Chirurgischen Maßnahmen kommt vor allem bei ausgeprägten Befunden und instabilen Narbenbildungen eine besondere Bedeutung zu. Neben der invasiven Wundreinigung bzw. Débridement und Infektsanierung sind zur dauerhaften Deckung der Hautdefekte vorrangig Verfahren mit lokaler und regionaler Übertragungen von Gewebe, selten auch freie Lappenplastiken etabliert. Ausgleich nutritiver Defizite und stringentes Komplikations- sowie Lagerungsmanagement stellen unabdingbare flankierende Maßnahmen dar.

Abstract

Decubitus ulcers develop due to pressure on tissue resulting in decreased perfusion of the affected region. Areas with bony prominences are mainly affected. At risk are immobile patients or patients with limited mobility as well as people with sensitivity disorders. Patients in advanced age are more endangered than younger ones regarding the development of pressure ulcers and this patient population usually presents with a combination of extrinsic and intrinsic risk factors; therefore, prevention and treatment of extensive tissue lesions are a particular multidisciplinary challenge with high socioeconomic significance in respect to the demographic change with an increasing proportion of elderly people. Surgical treatment is of special importance for extensive lesions and unstable scar tissue formation. In addition to invasive wound cleaning by lavage, debridement and bacterial decontamination, procedures with local and regional tissue transfer are given priority for permanent coverage of skin defects. Free tissue flap techniques are also established but are less commonly used. Nutrition, complication management and positioning of the patient are mandatory additional measures for improved outcome.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Gaab, M. Boyce und P. M. Vogt geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    J. Gaab, M. Boyce &  P.M. Vogt

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  1. J. Gaab
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  2. M. Boyce
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  3. P.M. Vogt
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Correspondence to P.M. Vogt.

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Gaab, J., Boyce, M. & Vogt, P. Plastisch-chirurgische Defektdeckung beim Dekubitus des Rumpfes und der Beckenregion. Chirurg 85, 1023–1038 (2014). https://doi.org/10.1007/s00104-013-2686-6

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