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DOI: 10.1055/s-2006-921514
© Georg Thieme Verlag Stuttgart · New York
Indikationen zum Einsatz der Vakuum-Therapie in der septischen orthopädischen Chirurgie
Indications for Use of the V.A.C.®-System in the Orthopedic SurgeryPublikationsverlauf
Publikationsdatum:
30. März 2006 (online)
![](https://www.thieme-connect.de/media/zblchir/2006S1/lookinside/thumbnails/10.1055-s-2006-921514-1.jpg)
Zusammenfassung
Einleitung: Die V.A.C.®-Therapie gilt als eine effiziente Option zur Behandlung von infizierten Wunden mit gestörten Heilungsverläufen. Über ihren Einsatz in der septischen orthopädischen Chirurgie wird selten berichtet. Ziel dieser Studie war es daher, die Anwendbarkeit des V.A.C.®-Systems zur Behandlung verschiedener Infektzustände im Bereich des Bewegungsapparates zu überprüfen und darzustellen. Patienten-Methoden: 6 verschiedene Entitäten mit bakteriellen Infekten (Hautnekrose nach Kniegelenksarthroplastik, Frühinfekt nach primärer Hüftprothesenimplantation, Z. n. Fibulaosteosynthese, dorsaler Spondylodese und Achillessehnenrekonstruktion sowie protrahierte Wundheilung nach Resektion und Bestrahlung eines Liposarkoms) wurden mit der V.A.C.®-Therapie behandelt. In 3 Fällen wurde nach gesicherter Infektsanierung eine ebenfalls V.A.C.®-unterstützte Meshgrafttransplantation durchgeführt. Ergebnisse: In allen Fällen war eine Infekteradikation unter Implantaterhalt gelungen. Die V.A.C.®-unterstützten Hauttransplantate waren komplikationslos eingeheilt. In einem durchschnittlichen Nachuntersuchungszeitraum von 36 Monaten war kein Reinfekt aufgetreten. Schlussfolgerung: Obwohl der Einsatz der V.A.C.®-Therapie kritisch indiziert werden sollte und größerer vergleichbarer Patientenkollektive bedarf, sind wir der Meinung, dass die Vakuumbehandlung eine wichtige Option bei orthopädischen Infektionen darstellt.
Abstract
Introduction: The vacuum-assisted closure (V.A.C.®)-therapy is accepted for an efficient option in the treatment of infected wounds with healing complications. However, reports on its use in the septic orthopedic surgery are seldom. Hence, the aim of this study is to demonstrate our experience with the V.A.C.®-system in the treatment of orthopedic-related infections. Patients-Methods: Various musculoskeletal infections with prolonged wound healing (infections after Achilles tendon reconstruction, fibula osteosynthesis, dorsal spondylodesis, and total hip arthroplasty, skin necrosis after total knee arthroplasty and wound dehiscence after resection and irradiation of a liposarcoma) have been treated with the V.A.C.®-device. After infection sanitation we performed skin graft transplantation in 3 cases for definitive wound closure, also assisted by the V.A.C.®-therapy. Results: An infection eradication with implant preservation, where neccessary, could have been achieved in all cases. No complications were observed in the cases with the skin graft transplantations. No infection persistence or reinfection occurred at a mean follow-up of 36 months. Discussion: The V.A.C.®-therapy seems to be a valuable adjunct in the treatment of infected wounds in the orthopedic surgery, however, definitive conclusion should await the results of future clinical studies with large series.
Schlüsselwörter
Infektion - V.A.C.®-Therapie - Implantaterhaltung
Key words
infection - V.A.C.®-therapy - hardware preservation
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Dr. med. K. Anagnostakos
Klinik für Orthopädie und Orthopädische Chirurgie · Universitätsklinikum des Saarlandes
Kirrbergerstr. 1
66421 Homburg/Saar
Telefon: 00 49/68 41/1 62 45 20
Fax: 00 49/68 41/1 62 45 16
eMail: konstantinos.anagnostakos@uniklinik-saarland.de