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Deep Sternal Wound Infections
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Deep Sternal Wound Infections
von: Raymund E. Horch, Christian Willy, Ingo Kutschka
Springer-Verlag, 2017
ISBN: 9783662497661
139 Seiten, Download: 16572 KB
Format:  PDF
geeignet für: Apple iPad, Android Tablet PC's Online-Lesen PC, MAC, Laptop

Typ: B (paralleler Zugriff)


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  Preface 5  
  Table of content 6  
  Editors 8  
  Authors 9  
  1Definition, Classification, and Epidemiology of Sternal Osteomyelitis 11  
     Definition 12  
     Classification 12  
     Epidemiology and Economic Considerations 13  
  2Anatomy and Blood Supply of the Sternum 16  
     Bony Anatomy 17  
     Relationship to Muscles 17  
     Development 18  
     Arterial Supply 19  
  3Pathophysiology of Sternal Osteomyelitis 22  
     Role of Bacteria 23  
     Biofilm 23  
     Caveats and Treatment Implications 24  
  4Stabilization of Thoracic Wall and Ventilatory Function by Negative Pressure Wound Therapy 26  
     Background 27  
     Sternal Instability and Flail Chest 27  
     Implications of Deep Sternal Wound Infections 27  
  5Radiological Diagnostics of Postoperative Sternal Osteomyelitis 30  
     Background 31  
     Computed Tomography 31  
     Radionuclide Imaging 32  
     X-rays 33  
     Magnetic Resonance Imaging 34  
  6Microbiological Aspects and Epidemiological Data of Poststernotomy Deep Sternal Wound Infection 37  
     Introduction 38  
     Literature Search 38  
     Results 38  
        Frequency of DSWI 38  
        Spectrum of Pathogens 40  
     Conclusions for Clinical Practice 42  
  7Primary Wound Management of Poststernotomy Infection 45  
     Prevention 46  
     Diagnosis 46  
     Treatment 46  
     How We Do It 47  
  8Negative Pressure Wound Therapy in Poststernotomy Deep Sternal Wound Infection 49  
     Introduction 51  
     The Principle of NPWT 51  
        Functional Principle 51  
        Example of Application 51  
        Effects on Wound Healing 52  
        Handling and Duration of Application 54  
     Literature Overview 54  
        Literature Search and Selection Method 54  
        Results 55  
        Aspects of Evidence-Based Medicine 56  
     Science Behind NPWT in DSWI 60  
        NPWT-Induced Change in Perfusion 60  
        Effects of Different Suction Strengths on Wound Sealing 69  
        Decontamination, Bacterial Clearance, and Immunological Effects of NPWT 69  
        Molecular Mechanisms in Wound Healing with NPWT 71  
        Microdeformational Effects of NPWT 72  
        Effect on Topical Antibiotic Concentrations 74  
     Technical Aspects of NPWT in Treatment of DSWI 74  
        Selection of Foam Material 74  
        Selection of Suction Strength 74  
        Selection of Vacuum Source 75  
        Complications of NPWT in DSWI 75  
        Contraindications 76  
     Conclusions for Clinical Practice 76  
  9Bone Stabilization Methods After Sternal Osteotomy 82  
     Introduction 83  
     Standard Technique of Sternal Osteosynthesis 83  
     Different Sternal Closure Techniques 84  
     Sternal Osteosynthesis Under Special Conditions 84  
     Sternal Osteosynthesis in Neonates and Infants 86  
  10Principles of Plastic Surgery in Sternal Osteomyelitis 89  
     Introduction 90  
     Involvement of the Plastic Surgeon 90  
     Principles of Regional Flaps Versus Free Flaps 90  
     Managing the Microbiobial Burden of Sternal Wounds During Defect Coverage 92  
     Principles of Plastic Surgical Management 92  
     Preventive Plastic Surgery in High-Risk Patients (Flap Delay) 93  
  11Plastic Surgical Methods of Defect Coverage in Sternal Osteomyelitis with Pedicled Flaps 96  
     Introduction 97  
     Pectoralis Major Flap 98  
     Rectus Abdominis Flap 99  
     Latissimus Dorsi Flap 101  
     Greater Omentum Flap 103  
     Conclusion 104  
  12Indications for Free Flap Coverage and Interdisciplinary Combined Approaches with Vascular Surgery AV Loops 106  
     Introduction 107  
     Indications for Free Flap Reconstruction 107  
     Surgical Procedure of Free Flap Transplantation and Combined Approaches 108  
     Conclusion 112  
  13Anesthesiological Management 114  
     Introduction 115  
     Anesthesiological Management of DSWI 115  
        Basic Monitoring 116  
        Advanced Monitoring 116  
        Echocardiography 117  
        Anesthetic Considerations and Intraoperative Management 117  
  14Rehabilitation After Sternal Osteomyelitis 119  
  15Prevention of Poststernotomy Wound Infections by Closed Incision Negative Pressure Therapy 122  
     Introduction 123  
     Literature Review: The Randomized Trials 123  
     Clinical Experiences With ciNPT 129  
     How Does the Cost–Benefit Analysis Look? 131  
     Can Evidence-Based Recommendations Be Formulated for ciNPT Use? 131  
        Patient-Related Risk Factors in Sternotomy 131  
        Operation-Related Risk Factors 132  
     Conclusion 133  
  Servicepart 137  
     Index 138  

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