Akute Embolie der A. brachialis bei einem Schwerbrandverletzten

Zusammenfassung

Thrombosen und Lungenembolien gehören zu den gefürchteten Komplikationen bei stationären Patienten. Eine Thromboseprophylaxe ist daher obligat. Arterielle Embolien treten im Rahmen des stationären Aufenthalts gehäuft bei Patienten mit Vorhofflimmern oder gefäßchirurgischen Patienten mit vorbestehender peripherer arterieller Verschlusskrankheit auf. Zu den häufigeren Komplikationen bei Verbrennungspatienten zählen neben Wundinfektion, Katheter-Assoziierte Infektion, die Lungenentzündung und der paralytische Ileus. In der Literatur gibt es dagegen kaum Berichte über akute arterielle Embolien in den Extremitäten nach Verbrennungstraumata. Wir stellen den Verlauf einer 60-jährigen Patientin vor, die sich im Rahmen eines häuslichen Unfalls tief II.-gradige Verbrennungen beider Beine von 15%KOF zugezogen hat. Im Rahmen der ersten Tage des stationären Aufenthaltes zeigte die Patientin eine schmerzbedingte Bewegungseinschränkung der linken Hand. Bei klinisch auffälliger Durchblutungsstörung waren die peripheren Pulse nicht tast- oder dopplerbar. Eine notfallmäßig durchgeführte Angiografie zeigte einen akuten Verschluss der A. brachialis. Die offene Embolektomie erfolgte. Der weitere Verlauf war komplikationslos. Nach Débridement der Verbrennungswunden und Spalthauttransplantation wurde die Patientin nach 35 Tagen in die Rehabilitation entlassen.

Abstract

Thrombosis and pulmonary embolisms are the most common complications in the hospital. The need for anticoagulation during hospital stay is obligatory. Arterial embolisms are rare. They often take place in patients with a pre-existing peripheral artery occlusive disease or in patients with atrial fibrillation. The most common complications in burn patients are wound infection, pneumonia, catheter-associated infections and paralytic ileus. There are almost no data available regarding arterial embolism in burn patients. Therefore we would like to present the case of a 60-year-old woman who was injured by a fire at home and was transported to our special burn unit. She sustained partial thickness burns of both legs and buttocks. The TBSA was 15%. During the first days of clinical stay the patient suffered from a pain induced movement reduction of the left hand. There were no peripheral pulses palpable or by pulsed-wave Doppler detectable. An urgent selected angiography of the left arm was performed and a arterial embolism of the proximal part of the a. brachialis was detected. The patient was operated immediately. After debridement and split-skin graft of the burn wounds the patient was taken to rehabiliation after 35 days.

Schlüsselwörter

Verbrennungschirurgie - Verbrennungsintensivmedizin - obere Extremität  - untere Extremität - arterielle Embolie

Key words

burn surgery - intensive care medicine for burns - upper limb - lower limb - arterial embolism

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