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. 2022 Mar;125(3):227-242.
doi: 10.1007/s00113-021-01135-y. Epub 2022 Feb 11.

[Blast injuries part 2 : Principles of medical treatment]

[Article in German]
Thorsten Hauer  1 , Steffen Grobert  2 , Jasmin Gaab  3 , Niels Huschitt  2 , Christian Willy  3
Affiliations

[Blast injuries part 2 : Principles of medical treatment]

[Article in German]
Thorsten Hauer et al. Unfallchirurg. 2022 Mar.

Abstract
in English, German

Explosions can cause severe injuries, which affect multiple organ systems and leave extensive soft tissue defects. In unstable patients, damage control surgery initially focuses exclusively on controlling bleeding and contamination with the aim of preserving life and limbs. The excision of all necrotic tissue, extensive wound irrigation with antiseptic solutions and a calculated antibiotic prophylaxis, which is subsequently adapted to the microbiological findings, are the basis for sufficient infection control. As the tissue damage caused by the pressure surge can regenerate over time as well as become secondarily necrotic (developing wounds), several revision operations are often necessary to assess the viability of tissue in the sense of serial debridement. In the case of extensive soft tissue injuries temporary vacuum-assisted closure (VAC) techniques can bridge the time to the earliest possible definitive plastic surgical wound closure; however, this must not delay the closure of the defect.

Explosionen können schwere Verletzungen hervorrufen, die mehrere Organsysteme betreffen und ausgedehnte Weichteildefekte hinterlassen. Bei instabilen Patienten konzentriert sich die „damage control surgery“ zunächst auf die Blutungs- und Kontaminationskontrolle, mit dem Ziel des Lebens- und Extremitätenerhalts. Exzision des nekrotischen Gewebes, antiseptische Wundspülungen und kalkulierte Antibiotikaprophylaxe, die im Verlauf an die mikrobiologischen Befunde angepasst wird, stellen die Grundlage für eine suffiziente Infektkontrolle dar. Da sich die durch den Druckstoß bedingten Gewebeschäden mit der Zeit sowohl regenerieren als auch sekundär nekrotisch werden können, sind oft mehrere Revisionsoperationen im Sinne eines seriellen Débridements erforderlich. Bei großflächigen Weichteilverletzungen kann die temporäre Vakuumversiegelungstechnik die Zeit bis zum frühestmöglich anzustrebenden definitiven plastischen Wundverschluss überbrücken; diese darf jedoch den Defektverschluss nicht verzögern.

Keywords: Amputation; Extremity injuries; Infection control; Soft tissue injuries; Wound closure techniques.

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References

Literatur

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