Grundlegende Techniken des Wundverschlusses in der Notaufnahme

Abstract

Wound management is one of the major tasks in emergency departments. The surrounding intact skin but not the wound itself should be disinfected before starting definitive wound treatment. Hair should first be removed by clipping to 1-2 mm above the skin with scissors or clippers as shaving the area with a razor damages the hair follicles and increases the risk of wound infections. Administration of local anesthetics should be performed directly through the exposed edges of the wound. After wound examination, irrigation is performed with Ringer's solution, normal saline or distilled water. The next step is débridement of contaminated and devitalized tissue. There are several wound closure techniques available, including adhesive tapes, staples, tissue adhesives and numerous forms of sutures. Management of specific wounds requires particular strategies. A bleeding control problem frequently occurs with scalp lacerations. Superficial scalp lacerations can be closed by alternative wound closure methods, for example by twisting and fixing hair and the use of tissue adhesives, i.e. hair apposition technique (HAT). For strongly bleeding lacerations of the scalp, the epicranial aponeurosis should be incorporated into the hemostasis. Aftercare varies depending on both the characteristics of the wound and those of the patient and includes adequate analgesia as well as minimizing the risk of infection. Sufficient wound aftercare starts with the treating physician informing the patient about the course of events, potential complications and providing relevant instructions.

Finding the Optimal Surgical Incision Pattern—A Biomechanical Study

“…3D-printed incision-pattern templates were used to standardize skin incisions as well as suture positions (Ultimaker 2+; Ultimaker, Utrecht, The Netherlands). The sutures were placed 8 mm from the edge of the wound and 10 mm apart from each other, as described previously [12]. All incisions used had a length of 4 cm (in a horizontal direction), resulting in 1 cm intact skin bilaterally between the end of the incision and the border of the template (Figure 1).…”

Versorgung akuter Wunden (Verband, Naht/Kleben) – Schritt für Schritt

“…▪ primäre Wundheilung ohne Defektheilung (durch primäre Adaptation der Wundränder und geringe Bindegewebsbildung) und die ▪ sekundäre Wundheilung mit Defektheilung unter Ausbildung einer Narbe (mit oder ohne sekundären Wundverschluss) [1,2].…”

“…Kinder unter 6 Jahren erhalten einen Kombinationsimpfstoff mit TDaP, ältere Kinder und Jugendliche Tdap. Erwachsene erhalten ebenfalls Tdap, wenn sie noch keine Pertussis-Impfung im Erwachsenenalter ( ≥ 18 Jahre) erhalten haben oder sofern eine aktuelle Indikation für eine Pertussis-Impfung besteht 2. TIG = Tetanus-Immunglobulin.…”

Basics der Wundversorgung

“…Durch sparsame Exzision (1-3 mm) der devitalisierten bzw. verschmutzten Wundränder mit einem Skalpell (Gr 10,11,15). in der Technik nach Friedrich (▶ Abb.…”