Der tiefe sternale Wundinfekt nach Sternotomie

Zusammenfassung

Der tiefe sternale Wundinfekt (TSWI) ist eine seltene Komplikation nach Sternotomie, die mit hoher Morbidität und Mortalität behaftet ist und Krankenhausaufenthalt sowie die Behandlungskosten signifikant ansteigen lässt. Eine mikrobiologische Besonderheit ist die Ausbildung von Biofilmen auf Implantatmaterial und/oder Knochensequestern. Die Diagnose wird anhand der klinischen Symptomatik der lokalen Entzündungsreaktion gestellt und durch systemische Infektionszeichen gestützt. Eine frühzeitige und gemeinsame Konsensfindung, welche die oft interdisziplinäre Behandlungsstrategie festlegt, ist dabei essenziell. Die Behandlung besteht i. d. R. aus mehreren chirurgischen Wunddebridements mit zwischenzeitlicher Wundkonditionierung, bis ein ausreichend sauberer Wundstatus erreicht ist. Zur Infektsanierung und für den Wundverschluss stehen je nach Größe und Lokalisation des Gewebedefektes eine Vielzahl verschiedener gestielter und freier Lappenplastiken zur Auswahl.

Abstract

Deep sternal wound infection (TSWI) is a potentially life-threatening complication that may occur after median sternotomy, contributing to prolonged hospital stay and increased health care costs. Bacterial infection is often characterized by biofilm formation on implant material and/or dead bone. Diagnosis is made upon clinical signs and symptoms of local and systemic infection. Early multidisciplinary decision making is needed for optimal patient care. Repeated surgical wound debridements accompanied by wound conditioning are performed until clean circumstances are achieved. Thereafter, wound closure and defect reconstruction are obtained using a variety of pedicled and microvascular flaps.

Schlüsselwörter

Gestielte Lappenplastiken - freie Lappenplastiken - Infektion - Sternum

Key words

Pedicled flaps - free flaps - infection - Sternum

Publikationsverlauf

Eingereicht: 13. Januar 2021

Angenommen: 01. März 2021

Artikel online veröffentlicht:
05. Mai 2021

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