Das Dekubitalulkus

Zusammenfassung

Von allen stationär betreuten Patienten der Universitätsklinik Leuven leiden 7,6 % (n = 134/1 769) unter Druckgeschwüren (Norton-Skala 10,4 Punkte). Unter Risiko-Patienten steigt der Anteil auf 30,1 %. Betroffen sind vorwiegend geriatrische, oder Patienten von Intensivstationen. Dem Chirurgen stehen zum Defektverschluss unterschiedliche Lappentypen zur Verfügung. Fasziokutane Lappen, wie der SGAP (superior gluteal artery perforator flap), sind besonders gegenüber mechanischen Beanspruchungen resistent. Hautmuskellappen dienen als Arbeitspferde für Dekubitalulzera mit tiefreichenden Taschenbildungen oder bei Osteitiden (Campbell Stadium > IV). Unter Beachtung von Mehrfachnennungen hatten mehr als 50 % der operierten Patienten Komplikationen. Partielle Lappennekrosen traten in 6 % der Fälle auf, in 2 % kam es zu kompletten Lappenverlusten. Unabhängig vom gewählten Weichteilverschluss werden 50 % aller Fälle langfristig Rezidive entwickeln. In Europa sind die Krankenhauskosten für Dekubitus-Patienten 2,5-fach höher als die stationären Behandlungskosten eines Durchschnitts-Patienten ohne Druckgeschwür. Daher kommt der Prävention eine herausragende Bedeutung zu.

Abstract

7.6 % (n = 134/1 769) of all inpatients in Leuven, but 30.1 % of risk patients suffer of pressure sores (Norton Scale 10.4 points). Predisposed are geriatric patients or those of intensive care units. While fasciocutaneous flap likewise the superior gluteal artery perforator flap are more resistant to mechanical forces, myocutaneous flaps are the working horse for pressure sores with deep-tissue pockets or osteitis (Campbell stage > IV). Partial resection of the median sacral crest or ischiectomy are obligatory. In analyzing a 16 years period only 33 percent of myocutaneous flaps healed uneventful, while due to multiple enumerations more than 50 percent presented complications. Partial flap and complete necrosis happened in 6 respectively in 2 percent. Rectus abdominis myocutaneous flap reconstruction as well as the free tissue transfer are useful alternatives to hip disarticulation with total thigh flap coverage or a complete fillet flap of the lower extremity. Independently of the selected closure 50 percent of all decubitus patients will develop recurrences in longterm follow up. Thus prevention is of utmost importance. In Europe the costs for the hospitalisation of a patient with concomitant decubital ulcers are 2.5-times higher than for an average, non-afflicted patient.

Dekubitalulkus - Druckgeschwür - Kreuzbein - Sitzbein - Trochanter femoris - Hautmuskellappen - Perforatorlappen - „Fillet”-Lappen - Rezidive - Epidemiologie - Behandlungskosten

Decubital ulcer - Pressure sores - Sacrum - Ischium - Femoral trochanter - Myocutaneous flaps - Perforator flaps - Total thigh flap - Recurrences - Epidemiology - Economical costs

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