RESUMO
The treatment of war injuries represents a continuing and recurrent challenge in modern reconstructive surgery. Previously, tumor resections and sepsis-related resections were mainly responsible for lengthy bone defects in Germany. In recent years another picture has increasingly emerged, particularly caused by the medical support of Ukraine. Aspects of military surgery are also becoming more important in civil hospitals, especially in the treatment of gunshot and explosion injuries. In Germany, war injuries are currently secondarily treated, as the distribution of patients is carried out according to the cloverleaf principle, weeks or months after the occurrence of the primary injury. In addition to complex bone and soft tissue defects of the extremities following such injuries, which often affect neural and vascular structures, reconstruction is often complicated by an increasing spectrum of multidrug-resistant pathogens. The definition of microbiological terms, such as contamination, colonization, critical colonization, local and systemic infections are important in the clinical routine in order to initiate a targeted treatment, especially in treatment with antibiotics. Wound swabs for determination of the spectrum of pathogens and the optimal testing of resistance are important for selecting the appropriate antibiotic agents. The concept of antibiotic stewardship (ABS) is established in many hospitals to improve the quality of antibiotic treatment and to minimize the formation of resistance. The selection of the method of reconstruction depends on the condition of the patient, the overall clinical constellation and the function to be expected after completion of treatment. The treatment of injuries due to violence and terrorism necessitates clear concepts and an interdisciplinary approach, especially with respect to microbiological challenges and increasing resistance situations.
Assuntos
Antibacterianos , Humanos , Antibacterianos/uso terapêutico , Alemanha , Lesões Relacionadas à Guerra , Procedimentos de Cirurgia Plástica/métodos , Medicina Militar/história , Medicina Militar/métodos , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/tratamento farmacológico , Gestão de Antimicrobianos , GuerraRESUMO
Die 3. Überarbeitung der S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung wurde unter der Federführung der Deutschen Gesellschaft für Unfallchirurgie (DGU) von insgesamt 26 Fachgesellschaften und Organisationen durchgeführt und stellt eine umfassende Aktualisierung der Handlungsempfehlungen zur Schwerverletzten-Versorgung auf Basis neuer wissenschaftlicher Erkenntnisse und Studien dar. Die Leitlinie enthält 332 Kernempfehlungen unterschiedlicher Empfehlungsgrade und dazugehörige Erläuterungen, die Expertenwissen und über 2400 zitierte Literaturstellen berücksichtigen und somit das höchste Niveau (S3) einer Leitlinie erfüllen. Die Änderungen, insbesondere zur Schockraumalarmierung, sind für den Rettungsdienst von besonderer Bedeutung. Zwei neue Kapitel mit Empfehlungen für die Blutstillung und Schmerzbehandlung in der prähospitalen Versorgung wurden hinzugefügt, insgesamt bleibt die Leitlinie ein wichtiger Standard für Entscheidungsfindungen bei Diagnostik und Therapie von Schwerverletzten.
