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Nervenverletzungen und posttraumatische Versorgung

Nerve injuries and posttraumatic therapy

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Zusammenfassung

Periphere Nervenverletzungen sind, v. a. im Rahmen eines Traumas, ein häufiges klinisches Problem und stellen oft eine Herausforderung dar. Die frühzeitige und adäquate Diagnosestellung sowie die daraus resultierende Therapie sind für den funktionellen Erhalt bzw. die Wiederherstellung entscheidend. Besonders nach kompletter Durchtrennung eines peripheren Nervs stellen die chirurgischen Techniken für dessen Koaptation eine wichtige Voraussetzung für seine Regeneration dar. Im vorliegenden Beitrag werden die Bedeutung und die Notwendigkeit der adäquaten Nervenkoaptation sowie der Transplantation von Nervenersatzmaterialien oder eines autologen Nervs detailliert dargestellt. Auch die Möglichkeiten der Primär- und Sekundärrekonstruktion werden beschrieben und der optimale Zeitpunkt der Nervenversorgung diskutiert. Somit ergibt sich ein umfassender Überblick über die Möglichkeiten zur Diagnosestellung sowie die Interventionsmöglichkeiten nach Nervenverletzung einschließlich eines Algorithmus zur chirurgischen Intervention. Auch mögliche Fehlerquellen und Einflussfaktoren auf die Regeneration und die Prognose werden aufgezeigt.

Abstract

Peripheral nerve injuries are a common clinical problem and can represent a major challenge, especially after trauma. In order to achieve optimal therapy, an early and adequate diagnosis with subsequent therapy is critical for functional preservation and restoration. Especially after complete severance of a peripheral nerve, the surgical techniques for nerve coaptation are an important prerequisite for peripheral nerve regeneration. The importance and necessity of adequate nerve coaptation and nerve transplantation are presented in detail. In addition, the types of primary and secondary nerve reconstruction procedures are described as well as the optimal time point of nerve repair. This article provides a comprehensive overview of the possibilities for diagnosis and intervention after nerve injury, additionally including an algorithm for surgical intervention. Furthermore, possible pitfalls and factors for improving the functional outcome are presented to optimize results with trauma-related nerve injury.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Radtke 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 und Poliklinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    C. Radtke & P.M. Vogt

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  1. C. Radtke
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  2. P.M. Vogt
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Correspondence to C. Radtke.

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Radtke, C., Vogt, P. Nervenverletzungen und posttraumatische Versorgung. Unfallchirurg 117, 539–556 (2014). https://doi.org/10.1007/s00113-014-2574-7

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