Postoperative Wundinfektionen – Zusammenfassung und Überblick

Iatrogene Wundinfektionen gehören zu den häufigsten Komplikationen in der Wirbelsäulenchirurgie. Für betroffene Patienten bedeutet eine Wundinfektion aufgrund des prolongierten Heilverlaufs eine sehr hohe physische und psychische Belastung. Die entsprechende Prävention, präoperative Optimierung der Patienten sowie die Therapiemaßnahmen sind nach wie vor hochaktuell, gerade im Zeitalter der Antibiotikatherapie.

Abstract

Postoperative wound infections of the spine are among the most common complications in spine surgery. Preoperative assessment of risk factors, classification of the infection, and diagnostics as well as treatment concepts must be considered. Currently, there are no generally accepted guidelines or therapeutical convention in the literature for the standardized treatment of wound infections. The depth of the infection plays a major role in the choice of therapy. A distinction is made between epifascial and subfascial infections, as well as early and late infections. The interaction between surgical measures and accompanying microbiological antibiotic administration is the basis of the therapy.

Kernaussagen

• Postoperative Wundinfektionen sind eine der häufigsten Komplikationen in der Wirbelsäulenchirurgie.

• Oftmals sind zahlreiche Folgeeingriffe erforderlich, bis die infizierte Wunde ausreichend therapiert ist. Für den Patienten bedeutet dies einen langen Leidensweg mit entsprechender physischer und psychischer Belastung.

• Postoperative Wundinfektionen bei Wirbelsäuleneingriffen <6 Wochen werden als „early Onset Infection“ >6 Wochen als „late Onset Infection“ definiert.

• Die Indikation zur Wundrevision bei klinischem Verdacht auf eine Wundinfektion ist frühzeitig zu stellen – kein „wait and see“!

• Wichtigste Maßnahmen der Behandlung sind das chirurgische Débridement mit Wundspülung und eine antibiogrammgerechte antibiotische Therapie.

• Die VAC-Behandlung ist ein zuverlässiges Hilfsmittel in der Infektbehandlung bei tiefen Infektionen und Frühinfektionen.

• Auch weiterhin existieren aufgrund der nicht eindeutigen Studienlage noch keine einheitlichen Therapierichtlinien.

Schlüsselwörter

Postoperative Wundinfektion - Revisionsoperationen - Komplikationen - Infektion - Wirbelsäule

Keywords

Postoperative wound infection - revision surgery - complications - infection - spine

Publication History

Article published online:
14 November 2022

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