Operative Interdisziplinarit�t?Extremit�ten

Abstract

Interdisciplinary reconstructive surgery of the extremities involves a variety of indications ranging from IIIB/C open fractures with major segmental loss of bone and soft tissue, to arterial vessel injury necessitating vascular repair, and to biological, plastic reconstruction following resection of musculoskeletal tumors. The multidisciplinary approach involving trauma/orthopedic surgery combined with vascular, plastic, and neuro- resp. microsurgery has significantly increased the rate of limb-sparing operations and improved morbidity, function, quality of life, and long-term oncological outcome. The multidisciplinary treatment of both complex trauma and malignant bone/soft tissue sarcoma of the extremity is an integral task of surgical trauma and tumor centers. Close interactive communication between the individual surgical disciplines has decisively influenced prognosis and is the precondition for priority-adapted therapeutic strategies.

A Systematic Review of the Orthoplastic Approach in Adult Lower Extremity Soft Tissue Sarcoma Flap Reconstruction

“…56 As a purely prognostic indicator, several studies have noted neoadjuvant radiation and chemotherapy to be associated with worse postoperative healing courses. [57][58][59][60][61] The ability of plastic surgeons to incorporate nonradiated tissue during reconstruction to address soft tissue defects not only benefits wound healing but can help to facilitate the delivery of higher radiation doses in cases of recurrent or invasive tumors. 57,59,61 Notably, our included studies primarily focused on reconstructive outcomes, making it impossible to thoroughly determine the effect of management options on oncological outcomes such as recurrence.…”

“…This is expected given that sarcomas are less likely to be responsive to systemic chemotherapy and are frequently treated with radiation. 57,58 However, both radiation and chemotherapy are known to disrupt cellular processes important to wound healing and therefore may potentially compromise wound healing. 56 As a purely prognostic indicator, several studies have noted neoadjuvant radiation and chemotherapy to be associated with worse postoperative healing courses.…”

Klinische Bedeutung der operativen Interdisziplinarität bei schweren Defektverletzungen der unteren Extremität

“…Trotz deutlicher Fortschritte in der Frakturbehandlung sowie in der Weichteilrekonstruktion stellen Patienten mit schweren Defektverletzungen der unteren Extremität nach wie vor eine besondere interdisziplinäre Herausforderung an die Chirurgie dar [17,20]. Da es sich hierbei häufig um Hochgeschwindigkeitsverletzungen im Straßenverkehr oder im Rahmen von Extrem-/ Funsportarten handelt, findet sich in vielen Fällen ein deutlich größerer Weichteilschaden als nach der ersten Inspektion angenommen wurde [21].…”