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Ein Zweistufenkonzept zur standardisierten Behandlung tiefer sternaler Wundinfektionen

A standardized two-step therapy for deep sternal wound infections

  • Operative Techniken
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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Tiefe sternale Wundinfektionen nach herzchirurgischen Eingriffen stellen im klinischen Alltag eine große Herausforderung dar und erfordern den Einsatz innovativer Therapiestrategien. Die V.A.C. (Vacuum Assisted Closure)®-Therapie hat sich in den vergangenen zehn Jahren zunehmend als Standard in der Behandlung komplizierter Wunden etabliert, und kann auch nach kardiochirurgischen Eingriffen mit Erfolg eingesetzt werden.

Das hier vorgestellte Zweistufenkonzept zur Behandlung sternaler Wundinfektionen basiert auf einer initialen Infektkontrolle mittels V.A.C.®-Therapie, an die sich ein sekundärer Wundverschluss anschließt. Wir präsentieren eine detaillierte Anleitung zur Durchführung entsprechender V.A.C.®-Therapien und diskutieren Vor- und Nachteile alternativer Verfahren. Techniken des sekundären Wundverschlusses, unter Einbeziehung plastisch chirurgischer Deckungsverfahren, werden angesprochen und sollen in einem Folgeartikel ausführlicher dargestellt werden.

Abstract

Deep sternal wound infection after cardiac surgery still represents a challenging complication in clinical practice and requires innovative therapeutic strategies. Over the past ten years, V.A.C. (Vacuum Assisted Closure)® therapy has been widely accepted as the gold standard in the management of complicated wounds and can also be successfully used following cardiac surgery.

We present our concept of a standardized two-step procedure and provide detailed guidelines for the implementation of V.A.C.® therapy to achieve initial infection control and induce wound healing. Secondary wound closure techniques are selected according to individual needs and may include reconstructive surgery with vascularized flaps.

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Zardo, P., Weishäupl-Karstens, P. & Kutschka, I. Ein Zweistufenkonzept zur standardisierten Behandlung tiefer sternaler Wundinfektionen. Z Herz- Thorax- Gefäßchir 23, 212–219 (2009). https://doi.org/10.1007/s00398-009-0726-9

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