357. ?Skrupelloses? Debridement zur Therapie von Frakturen mit ausgedehntem Weichteilschaden

Abstract

In a comparison of two groups of patients (identical according to age, sex and number of simultaneous injuries) we tried to evaluate radical and planned debridement (debridement every 48 h with removal of all avascular and badly perfused tissue) in patients with open fractures of the lower leg. We could demonstrate a correlation between adequate debridement and the frequency of posttraumatic osteitis, septic-toxic reactions and the incidence of amputation. "Unscrupulous" and planned debridement leads to a significant reduction of post-traumatic osteitis, a decrease in the frequency of amputation, shortening of the duration of hospitalization and, therefore, to a diminished loss of social and familial interaction.Summary. Breast reconstruction with the use of an upper rectus flap utilizes perforating cutaneous branches of the superior epigastric artery. Flap necrosis of various degrees, which occurred in our series of 26 patients at a rate of up to 30 %, prompted repeated dissection and perfusion studies. In 35 fixed and 12 fresh cadavers, 1 to 3 perforators with an average diameter of 0.5 mm were found in every specimen. Between 8 and 21 cm (average 13.5 cm) lateral to the median line, extensions of the perforators could be demonstrated. Clinical investigation showed a high risk of flap necrosis in irradiated patients and in those undergoing simultaneous prosthesis implantation.