Die Rolle von topischer Unterdrucktherapie/Vakuumtherapie in der orthoplastischen Chirurgie – NPWT, NPWTi-d und ciNPT

Zusammenfassung

Hintergrund

Wunden an den Extremitäten werden heute häufig zunächst durch eine lokale Unterdrucktherapie (Vakuumtherapie) behandelt, bevor eine Knochen- und Weichteilrekonstruktion erfolgt. Angestrebte Effekte sind hierbei unter anderem eine aktive Wundkonditionierung, mit dem übergeordneten Ziel des Erhalt der Extremität sowie der Wiederherstellung von Funktionalität und Lebensqualität. Die interdisziplinäre Zusammenarbeit bei der Behandlung ossärer sowie vaskulärer Pathologien, der Rekonstruktion und Rehabilitation wird als Ortho-Plastische Rekonstruktion bezeichnet.

Methodik

Die vorliegende Arbeit beschreibt zum einen wegweisende Meilensteine, die zur Entwicklung des orthoplastischen Konzeptes im Bereich der Extremitäten-Rekonstruktion geführt haben. Zudem werden im folgenden grundlegende Prinzipien der modernen Versorgungsstrategien, einschließlich der Wundbettkonditionierung mittels Vakuumtherapie, basierend auf der pertinenten Literatur, herausgearbeitet und anhand repräsentativer Beispiele erläutert.

Ergebnisse

Eine Übersicht der Literatur zeigt, dass sich die orthoplastische Chirurgie in verschiedenen Ländern zeitlich versetzt entwickelte. Erst durch moderne Techniken zur Skelettstabilisierung und Weichteilrekonstruktion fanden interdisziplinäre Konzepte, einschließlich der topischen Vakuumtherapie, Eingang in den klinischen Alltag. Die Vorteile des ortho-plastischen Ansatzes liegen in einer schnelleren Stabilisierung, frühzeitigen Weichteildeckung, verkürzter Hospitalisierungsdauer, reduzierten Komplikationsraten und besseren funktionellen Langzeitergebnissen.

Schlussfolgerung

Die lokale Unterdrucktherapie ist heute ein unverzichtbares Instrument im orthoplastischen Ansatz. Entscheidend ist die koordinierte Zusammenarbeit von plastisch-rekonstruktiver und unfallchirurgisch-orthopädischer Chirurgie zur zeitnahen Behandlung rekonstruktiver Extremitätenverletzungen. An spezialisierten Zentren hat sich dieses Vorgehen bewährt, um den optimalen Rekonstruktionszeitpunkt zu bestimmen und die Ergebnisse zu verbessern. Die frühere Annahme, eine Amputation sei oft vorteilhafter, wurde durch erfolgreiche orthoplastische Rekonstruktionen mit langfristigem Extremitätenerhalt widerlegt. Ein Erhalt der Extremität wird heute, wenn immer möglich, angestrebt.

Abstract

Background

Today, wounds of the extremities are often initially treated with localised negative pressure therapy (vacuum therapy) before bone and soft tissue reconstruction is performed. The aim is to preserve the limb and restore function and quality of life. The interdisciplinary collaboration in the treatment of neurovascular pathologies, reconstruction, and rehabilitation is known as orthoplastic reconstruction.

Methods

This paper outlines the milestones that have led to the development of the orthoplastic concept in limb reconstruction. In addition, the fundamental principles of modern treatment strategies, including wound bed conditioning with vacuum therapy, are discussed on the basis of relevant literature and illustrated with representative examples.

Results

A review of the literature shows that orthoplastic surgery developed at different times in different countries. It was only with the advent of modern techniques for skeletal stabilisation and soft tissue reconstruction that interdisciplinary concepts, including topical vacuum therapy, found their way into everyday clinical practice. Advantages of the orthoplastic approach include faster stabilisation, early soft tissue coverage, shorter hospitalisation times, reduced complication rates, and better long-term functional outcomes.

Conclusion

Today, localised negative pressure therapy is an indispensable tool in the orthoplastic approach. Close collaboration between plastic-reconstructive and trauma-orthopaedic surgery is essential for the timely management of reconstructive limb injuries. This approach has proven effective at specialised centres in determining the optimal time for reconstruction and improving outcomes. The earlier assumption that amputation is often more favourable has been refuted by successful orthoplastic reconstructions achieving long-term limb preservation. Today, the aim is to preserve the limb whenever possible.

Schlüsselwörter

Wundkonditionierung - Extremitätenrekonstruktion - Orthoplastische Chirurgie

Keywords

wound conditioning - limb reconstruction - orthoplastic surgery - NPWT - ciNPT - NPWTid

Publication History

Received: 27 April 2025

Accepted: 27 August 2025

Article published online:
11 December 2025

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