Zusammenfassung
Schussverletzungen sind in Deutschland selten und meist in suizidaler Absicht oder durch den unsachgemäßen Umgang mit Waffen verursacht. Die resultierenden Verletzungen stellen durch die Ausdehnung des Gewebeschadens und den komplikationsträchtigen Verlauf eine eigene Entität dar, die ein differenziertes Vorgehen erfordert. Da jedes Traumazentrum mit einer Schussverletzung jederzeit konfrontiert werden kann, gilt es, die Grundzüge der Behandlung präsent zu halten und regelmäßig zur Diskussion zu stellen.
Durch die Auslandseinsätze der Bundeswehr und resultierend aus der Versorgung von Patienten aus anderen Krisenregionen konnten wir zwischen 2005 und 2011 85 Schussverletzungen bei 64 Patienten versorgen. In der Mehrzahl der Fälle war die untere Extremität betroffen, und wir konnten ein extremitätenerhaltendes Behandlungsregime realisieren. Im Rahmen der vorliegenden Originalarbeit berichten wir über die Erfahrungen und Ergebnisse in der Versorgung von Schussverletzungen an der unteren Extremität.
Dieser Teil der Arbeit setzt sich mit der Epidemiologie und Pathophysiologie einer Schussverletzung an der unteren Extremität auseinander. Anhand der Auswertung mikrobiologischer Befunde einer Subgruppe mit Patienten aus einer Bürgerkriegsregion (n = 10) wird das Problem der Kontamination, Besiedelung und Infektion mit multiresistenten Keimen erläutert. Neben der Darstellung der Erst- und Notfallversorgung einer Schussverletzung werden die erforderlichen Maßnahmen zur weiteren Versorgung und Dekontamination dargelegt. Abschließend werden diese Ergebnisse mit der hierzu vorliegenden Literatur verglichen.
Abstract
Gunshot wounds are rare in Germany and are mostly the result of suicide attempts or improper handling of weapons. The resulting injuries involve extensive tissue damage and complications which are thus unique and require a differentiated approach. As trauma centers may be confronted with gunshot wounds at any time, treatment principles must be understood and regularly reevaluated.
Due to Bundeswehr operations abroad and the treatment of patients from other crisis regions a total of 85 gunshot wounds in 64 patients were treated between 2005 and 2011. In the majority of cases the lower extremities were affected and we were able to carry out treatment to preserve the extremities. In this article we report on our experiences and the results of treatment of gunshot wounds to the lower extremities.
This part of the article deals with the epidemiology and pathophysiology of gunshot wounds to the lower extremities. By means of an evaluation of microbiological findings in a subgroup of patients involved in a civil war (n = 10), the problem of multidrug resistant pathogen contamination, colonization and infection is discussed. In addition to a description of initial and emergency treatment of gunshot wounds, measures required for further treatment and decontamination are presented. Finally, the results are discussed with reference to the literature in this field.
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Interessenkonflikt. A. Franke, D. Bieler, A. Wilms, S. Hentsch, M. Johann, E. Kollig geben an, dass kein Interessenkonflikt besteht. Soweit der Beitrag personenbezogene Daten enthält, wurde von den Patienten eine zusätzliche Einwilligung nach erfolgter Aufklärung eingeholt. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Franke, A., Bieler, D., Wilms, A. et al. Behandlung von Schussfrakturen der unteren Extremität. Unfallchirurg 117, 975–984 (2014). https://doi.org/10.1007/s00113-014-2635-y
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DOI: https://doi.org/10.1007/s00113-014-2635-y