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Handchir Mikrochir Plast Chir 2014; 46(06): 375-378
DOI: 10.1055/s-0034-1381997
Fallbericht
© Georg Thieme Verlag KG Stuttgart · New York

Akute Embolie der A. brachialis bei einem Schwerbrandverletzten

Acute Upper Limb Embolism in a Severely Burned Patient
P. Wiebringhaus
1   Plastische und Ästhetische Chirurgie, Handchirurgie, Zentrum für Schwerbrandverletzte, Sana Klinikum Offenbach, Offenbach
,
T. Pierson
1   Plastische und Ästhetische Chirurgie, Handchirurgie, Zentrum für Schwerbrandverletzte, Sana Klinikum Offenbach, Offenbach
,
H. Menke
1   Plastische und Ästhetische Chirurgie, Handchirurgie, Zentrum für Schwerbrandverletzte, Sana Klinikum Offenbach, Offenbach
› Author Affiliations
Further Information

Publication History

eingereicht 14 March 2014

akzeptiert 12 May 2014

Publication Date:
07 January 2015 (online)

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Zusammenfassung

Thrombosen und Lungenembolien gehören zu den gefürchteten Komplikationen bei stationären Patienten. Eine Thromboseprophylaxe ist daher obligat. Arterielle Embolien treten im Rahmen des stationären Aufenthalts gehäuft bei Patienten mit Vorhofflimmern oder gefäßchirurgischen Patienten mit vorbestehender peripherer arterieller Verschlusskrankheit auf. Zu den häufigeren Komplikationen bei Verbrennungspatienten zählen neben Wundinfektion, Katheter-Assoziierte Infektion, die Lungenentzündung und der paralytische Ileus. In der Literatur gibt es dagegen kaum Berichte über akute arterielle Embolien in den Extremitäten nach Verbrennungstraumata. Wir stellen den Verlauf einer 60-jährigen Patientin vor, die sich im Rahmen eines häuslichen Unfalls tief II.-gradige Verbrennungen beider Beine von 15%KOF zugezogen hat. Im Rahmen der ersten Tage des stationären Aufenthaltes zeigte die Patientin eine schmerzbedingte Bewegungseinschränkung der linken Hand. Bei klinisch auffälliger Durchblutungsstörung waren die peripheren Pulse nicht tast- oder dopplerbar. Eine notfallmäßig durchgeführte Angiografie zeigte einen akuten Verschluss der A. brachialis. Die offene Embolektomie erfolgte. Der weitere Verlauf war komplikationslos. Nach Débridement der Verbrennungswunden und Spalthauttransplantation wurde die Patientin nach 35 Tagen in die Rehabilitation entlassen.

Abstract

Thrombosis and pulmonary embolisms are the most common complications in the hospital. The need for anticoagulation during hospital stay is obligatory. Arterial embolisms are rare. They often take place in patients with a pre-existing peripheral artery occlusive disease or in patients with atrial fibrillation. The most common complications in burn patients are wound infection, pneumonia, catheter-associated infections and paralytic ileus. There are almost no data available regarding arterial embolism in burn patients. Therefore we would like to present the case of a 60-year-old woman who was injured by a fire at home and was transported to our special burn unit. She sustained partial thickness burns of both legs and buttocks. The TBSA was 15%. During the first days of clinical stay the patient suffered from a pain induced movement reduction of the left hand. There were no peripheral pulses palpable or by pulsed-wave Doppler detectable. An urgent selected angiography of the left arm was performed and a arterial embolism of the proximal part of the a. brachialis was detected. The patient was operated immediately. After debridement and split-skin graft of the burn wounds the patient was taken to rehabiliation after 35 days.

Schlüsselwörter

Verbrennungschirurgie - Verbrennungsintensivmedizin - obere Extremität  - untere Extremität - arterielle Embolie

Key words

burn surgery - intensive care medicine for burns - upper limb - lower limb - arterial embolism
 

  • Literatur

  • 1 Mullins F, Mian MA, Jenkins D et al. Thromboembolic complications in burn patients and associated risk factors. J Burn Care Res 2013; 34: 355-360
    CrossrefPubMedGoogle Scholar
  • 2 Heit JA, Cohen AT, Anderson FA et al. Estimated annual number of incident and recurrent, non-fatal and fatal venous thromboembolism (VTE) events in the US. Blood 2005; 106: 267A
    PubMedGoogle Scholar
  • 3 Cohen AT, Agnelli G, Anderson FA et al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007; 98: 756-764
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Geerts WH, Bergqvist D, Pineo GF et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 2008; 133 (Suppl. 06) 381S-453S
    CrossrefPubMedGoogle Scholar
  • 5 Murray DW. Embolism in peripheral arteries. Can Med Assic J 1935; 35: 61-66
    PubMedGoogle Scholar
  • 6 Banis Jr JC, Rich N, Whelan Jr TJ. Ischemia of the upper extremity due to noncardiac emboli. Am J Surg 1977; 134: 131-139
    CrossrefPubMedGoogle Scholar
  • 7 Mourot JM, Oliveira HM, Woodson LC et al. Complications of femoral artery catheterization in pediatric burn patients. J Burn Care Res 2009; 30: 432-436
    CrossrefPubMedGoogle Scholar
  • 8 Andersen LV, Mortensen LS, Lip GY et al. Atrial fibrillation and upper limb thromboembolectomy: a national cohort study. J Thromb Haemost 2011; 9: 1738-1743
    CrossrefPubMedGoogle Scholar
  • 9 Stonebridge PA, Clason AE, Duncan AJ et al. Acute ischaemia of the upper limb compared with acute lower limb ischaemia; a 5-year review. Br J Surg 1989; 76: 515-516
    CrossrefPubMedGoogle Scholar
  • 10 Sachatello CR, Ernst CB, Griffen Jr WO. The acutely ischemic upper extremity: selective management. Surgery 1974; 76: 1002-1009
    PubMedGoogle Scholar
  • 11 DeguaraJ AliT, Modarai B. Upper limb ischemia: 20 years experience from a single center. Vascular 2005; 84-91
    PubMedGoogle Scholar
  • 12 Siemers F, Kaun M, Machens HG et al. Mesenteric ischemia: a severe complication in burn patient. Handchir Mikrochir Plast Chir 2007; 39: 364-368
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Van Haren RM, Thorson CM, Valle EJ et al. Hypercoagulability after burn injury. J Trauma Acute Care Surg 2013; 75: 37-43
    CrossrefPubMedGoogle Scholar
  • 14 Scott JR, Klein MB, Gernsheimer T et al. Arterial and venous complications of heparin-induced thrombocytopenia in burn patients. J Burn Care Res 2007; 28: 71-75
    CrossrefPubMedGoogle Scholar
  • 15 Busche MN, Herold C, Krämer R et al. Evaluation of prophylactic anticoagulation, deep venous thrombosis, and heparin-induced thrombocytopenia in 21 burn centers in Germany, Austria, and Switzerland. Ann Plast Surg 2011; 67: 17-24
    CrossrefPubMedGoogle Scholar
  • 16 Creager MA, Kaufman JA, Conte MS. Clinical practice. Acute limb ischemia. N Engl J Med 2012; 366: 2198-2206
    CrossrefPubMedGoogle Scholar
  • 17 Pentti J, Salenius J-P, Kuukasjarvi P et al. Outcome of surgical treatment in acute upper limb ischaemia. Ann Chir Gynaecol 1995; 84: 25-28
    PubMedGoogle Scholar
  • 18 Satiani B, Gross WS, Evans WE. Improved limb salvage after arterial embolectomy. Ann Surg 1978; 188: 153-157
    CrossrefPubMedGoogle Scholar
  • 19 Fogarty TJ, Cranley JJ, Krause RJ et al. A method for extraction of arterial emboli and thrombi. Surg Gynecol Obstet 1963; 116: 241-244
    PubMedGoogle Scholar
  • 20 AWMF-Leitlinie Medikamentöse Therapie nach gefäßchirurgischen Operationen und endovaskulären Interventionen 2010
    PubMed
  • 21 Camm AJ, Kirchhof P, Lip GY et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). European Heart Rhythm Association; European Association for Cardio-Thoracic Surgery. Eur Heart J 2010; 31: 2369-2429
    CrossrefPubMedGoogle Scholar
  • 22 Lin H, Faraklas I, Cochran A et al. Enoxaparin and antifactor Xa levels in acute burn patients. J Burn Care Res 2011; 32: 1-5
    CrossrefPubMedGoogle Scholar
  • 23 To KB, Napolitano LM. Common complications in the critically ill patient. Surg Clin North Am 2012; 92: 1519-1557
    CrossrefPubMedGoogle Scholar