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Infektionen nach sogenannten Bagatellverletzungen der Hand

Infections following so-called minor hand injuries

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Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Eine drohende folgenschwere Infektion ist bei bestimmten Verletzungen der Hand auf den ersten Blick oft nicht ersichtlich.

Fragestellung

Oft unterschätzte Verletzungen der Hand und häufige Infektionsrisiken werden erörtert, um zu einer realistischen Einschätzung der Prognose zu verhelfen.

Material und Methode

Es wurde eine Literaturübersicht durchgeführt, um Infektionsrisiken der Hand und oft unterschätzte Verletzungsformen zu identifizieren. Die Infektionsrisiken und Verletzungsformen werden unter dem Aspekt der Früherkennung und der rechtzeitigen angemessenen Behandlung unter Berücksichtigung neuester wissenschaftlicher Veröffentlichungen diskutiert.

Ergebnisse

Schon geringe Entzündungszeichen bei bestimmten Patientengruppen, Wundeigenschaften, Fremdkörper- oder Biss- und Hochdruckinjektionsverletzungen sollten zu einem rechtzeitigen adäquaten chirurgischen Débridement veranlassen. Im Verlauf sollte regelmäßig geprüft werden, ob ein Missverhältnis in Bezug auf die Anzahl und die Virulenz der Keime und der Immunkompetenz des Patienten vorliegt, um ggf. erneut chirurgisch zu intervenieren. Die alleinige antibiotische Behandlung kann bei abgekapselten Prozessen oder einer Fremdkörperinkorporation die lokale infektbedingte Gewebezerstörung nicht aufhalten, birgt jedoch die Gefahr der Symptomverschleierung und somit der Infektionsverschleppung und einer Resistenzentwicklung.

Schlussfolgerungen

Ein chirurgisches Débridement von Handverletzungen ist bei bestimmten Verletzungsmustern und Patientengruppen schon bei geringen Infektionszeichen angezeigt.

Abstract

Background

Serious infections resulting from seemingly harmless wounds are often difficult to predict.

Objectives

We sought to identify often underestimated injuries of the hand and associated factors which may help to reliably predict the risk of infection.

Materials and methods

A literature review was conducted to identify the risk of infections in small and superficial injuries of the hand as well as specific forms of injuries that are frequently underestimated. Reflecting the most recent literature, we discuss the risks of infection and seemingly harmless injury patterns that require prompt surgical intervention.

Results

Early and adequate surgical debridement is highly recommended when minor signs of infection are present in susceptible patients or wounds, in case of foreign body injuries and bite injuries or in any high-pressure injection injury. Follow-up examinations at regular intervals are necessary to verify that immune response is strong enough to eliminate foreign invaders before their populations grow beyond control, mandating surgical intervention. Antibiotic treatment only is inadequate for encapsulated infections or foreign body injuries. However, it may dissimulate symptoms which would otherwise have led to consideration of surgical debridement and, therefore, delays appropriate treatment and may increase the risk of development of drug resistance.

Conclusion

Surgical debridement should not be delayed when minor signs of infection are present in susceptible patients or in specific patterns of injury of the hand.

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Authors and Affiliations

  1. Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG-Unfallklinik Tübingen, Eberhard-Karl-Universität Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland

    S. Stahl M.D., M. Held M.D., F. Medved M.D., T. Manoli M.D. & H.-E. Schaller M.D., Ph.D.

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  1. S. Stahl M.D.
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  2. M. Held M.D.
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  3. F. Medved M.D.
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  4. T. Manoli M.D.
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  5. H.-E. Schaller M.D., Ph.D.
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Correspondence to S. Stahl M.D..

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Interessenkonflikt

S. Stahl, M. Held, F. Medved, T. Manoli und H.‑E. Schaller geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigen oder des gesetzlich bestellten Betreuers vor.

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Stahl, S., Held, M., Medved, F. et al. Infektionen nach sogenannten Bagatellverletzungen der Hand. Trauma Berufskrankh 21 (Suppl 1), 103–108 (2021). https://doi.org/10.1007/s10039-020-00472-2

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