A decrease in rate of amputation has been reported from many countries. This study aims to study the trends in amputation rates in Germany. On the basis of DRG-system, detailed lists of all amputations coded as minor amputations (OPS 5-864) and major amputations (OPS 5-865) performed between 2005 and 2010 were provided by the Federal Statistical Office. There was a significant decrease in age-adjusted major amputation rates per 100 000 population in Germany from 27·0 in 2005 to 22·9 in 2010 (15·2%, P ≪ 0·001) in males and from 19·7 in 2005 to 14·4 in 2010 (26·9%, P ≪ 0·001) in females. Overall, minor amputation rates did not show such a decrease but increased in males (from 47·4 in 2005 to 57·8 in 2010, 21·9%, P ≪ 0·001) and remained almost unchanged in females (23·1 in 2005 and 23·9 in 2010, not significant). Reduction in major amputation rates were even more pronounced in people above 80 years, especially in males from 216 to 150 (30·5%) and in females from 168 to 117 (30·4%). The present data demonstrate an increasing overall burden of foot lesions as indicated by an increase in incidence of minor amputations but an ongoing success in the fight against amputation, resulting in a significant decrease in major amputation rates in Germany, in the 6-year period from 2005 to 2010.

Exact data regarding the clinical role of maggot debridement therapy (MDT) for wound care in a specific country are not available. Thus, we analysed the use of MDT in hospitalised patients in Germany. Detailed lists of all hospitalised cases treated with MDT in Germany for the years 2011 to 2016 were provided by the Federal Statistical Office as well as the lists of the 15 most frequent principal and additional diagnoses, respectively, and the 10 most frequent procedures documented with MDT in 2016. Within the 6-year time period of the study, the number of cases treated with MDT increased by 11% from 4513 in 2011 to 5.017 in 2016. Lower leg and foot were the most frequent anatomic sides of treatment counting up to 83.9% of all cases. In addition, MDT procedures for temporary soft tissue coverage including negative pressure wound therapy were often performed: for treatment of large areas in 36.7% and small areas in 6.2%. 41.3% of all cases treated with MDT had infection with Escherichia coli and 35.9% of all cases with Bacillus fragilis. Our analysis shows a limited use of MDT with a small increase only in the last 6 years in German hospitals. MDT is predominately used to treat foot or leg ulcers.

Background: Although the underlying primary cause of chronic wounds may vary, a common etiology of this is a hypoxic or ischemic status of the affected tissue of the lower extremities. In particular, for rare diseases associated with disturbed blood flow a correlation between cause and effect is often diagnosed inappropriately. As a consequence, chronic wounds may develop and persist for years. Main observations:We present a case of a patient with chronic venous insufficiency due to an occlusion of the inferior caval vein. Initially, a Budd-Chiari syndrome was diagnosed which is a thrombotic obstruction of the hepatic venous outflow. In addition, the patient developed an obstruction of the inferior caval vein and subsequently a chronic venous insufficiency. As a consequence, chronic leg ulcers developed with a history of more than 7 years. Various wound care approaches were performed without success in wound closure. Finally, a combination of compression therapy and topical application of a hemoglobin solution successfully led to fast and persistent wound closure.

ZusammenfassungDie Shave-Therapie als rein symptomatisches Verfahren in der operativen Behandlung chronisch-venöser Beingeschwüre und hat sich gegen die Methoden mit kausalem Therapieansatz (Fasziektomie, Fasziotomie) zu bewähren. Ziel unserer Untersuchung ist die Darstellung der Langzeitergebnisse nach Shave-Therapie, sowie die Bedeutung standardisierter postoperativer und poststationärer Maßnahmen auf die Ergebnisqualität. Patienten, Methoden: Im Zeitraum vom 1.1.1998 bis 31.3.2005 wurden 193 Patienten (249 erkrankte Beine) mit insgesamt 335 Shave-Therapien behandelt. Ergebnisse: Die mittlere Ulkusdauer bis zur operativen Sanierung betrug 16,3 Jahre (0,4–62 Jahre). Bei der letzten Kontrolle (3/2005) waren 197 Beine komplett abgeheilt (79,2%), 21 Beine (8,4%) zeigten bei Entlassung noch kleine Restläsionen, 31 Beine (12,4%) mussten als Therapieversager eingestuft werden. Die mittlere Nachbeobachtungszeit beträgt derzeit 43,5 Monate (1–87 Monate). Schlussfolgerung: Der therapeutische Erfolg ist im Wesentlichen begründet durch standardisierte Behandlungskonzepte, regelmäßige Kontrollen und Führung der Patienten in einem Ulkus-Register mit hoher Compliance.

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