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„damage control surgery“ bei schweren abdominellen Verletzungen

Damage control surgery in severe abdominal trauma

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Das Konzept der Versorgung schwerster abdomineller Verletzungen nach Prinzipien des „damage control“ findet auch im deutschen Sprachraum zunehmend Verbreitung. Die Indikation zur „damage control“-Versorgung stellt sich bei Vorliegen der Trias Azidose, Hypothermie und Koagulopathie (AHK-Syndrom). Als Zugang wird eine Medianlaparotomie gewählt. Bei Hohlorganverletzungen wird keine primäre Anastomose erzwungen, im Vordergrund steht die Kontaminationskontrolle. Methoden der Wahl sind die Anlage eines Anus praeter oder der temporäre Blindverschluss. Bei Milzrupturen steht die Splenektomie im Vordergrund. Massiv blutende Leberverletzungen werden durch Packing ggf. mit temporärer Gefäßokklusion kontrolliert. Abschließend erfolgt ein temporärer Bauchdeckenverschluss. Nach intensivmedizinischer Stabilisierung wird eine definitive Versorgung im Intervall vorgenommen.

Abstract

The concept of treating severe abdominal trauma according to the principles of damage control surgery is becoming more widespread in Germany. Damage control surgery is indicated when evidence of AHC syndrome, meaning the combination of acidosis, hypothermia and coagulopathy, is found. The preferred surgical approach is the median laparotomy. In hollow organ injury a primary anastomosis should not be forced; contamination control is far more important. Methods of choice are construction of an anus preter or temporary blind closure. In the case of splenic injury total splenectomy is commonly performed. Liver injuries with massive bleeding should be controlled by packing or interim vascular occlusion, with subsequent temporary closure of the abdominal wall. Definitive organ repair should follow stabilization in the intensive care unit.

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Authors and Affiliations

  1. Unfall- und Wiederherstellungschirurgie, Ernst-Moritz-Arndt-Universität, Greifswald

    G. Matthes, K. Bauwens, A. Ekkernkamp & D. Stengel

  2. Klinik für Unfall- und Wiederherstellungschirurgie, Unfallkrankenhaus Berlin

    G. Matthes, K. Bauwens, A. Ekkernkamp & D. Stengel

  3. Zentrum für Klinische Forschung, Unfallkrankenhaus Berlin

    K. Bauwens, A. Ekkernkamp & D. Stengel

  4. Unfall- und Wiederherstellungschirurgie, Ernst-Moritz-Arndt-Universität, Sauerbruchstraße, 17475 , Greifswald

    G. Matthes

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  1. G. Matthes
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  2. K. Bauwens
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  3. A. Ekkernkamp
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  4. D. Stengel
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Correspondence to G. Matthes.

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Matthes, G., Bauwens, K., Ekkernkamp, A. et al. „damage control surgery“ bei schweren abdominellen Verletzungen. Trauma Berufskrankh 8, 13–16 (2006). https://doi.org/10.1007/s10039-006-1103-5

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  • DOI: https://doi.org/10.1007/s10039-006-1103-5

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