Steinau H U, Clasbrummel B, Josten C, Homann H H, Lehnhardt M, Druecke D
Universitätsklinik für Plastische Chirurgie und Schwerbrandverletzte, BG-Kliniken Bergmannsheil, Ruhr-Universität Bochum.
Chirurg. 2004 Apr;75(4):390-8. doi: 10.1007/s00104-004-0852-6.
In cases of extended post-traumatic soft-tissue and bone loss as well as with mutilating infection or radical tumor resection, multidisciplinary options are required to salvage extremities and functional rehabilitation. A surgical team approach allows for reduction of amputation rates, wound healing complications, and secondary procedures in limb oncology and trauma. The goals and limitations of cooperative surgical concepts are described. In the future, continuing medical education will focus not only on indications and techniques but also on complication management, medicolegal problems, and economic deficits due to maladapted legal structures. Provided clear clinical pathways are introduced to guide indications, surgical procedures, and postoperative treatment, marked financial deficits may be avoided. While, in the past, responsibility for the patient and ethical considerations resulted in the development of voluntary interdisciplinary treatment programs, economic strategies and an increasing number of malpractice suits will inevitably produce new imperatives for interdisciplinary cooperation in the future.
在创伤后软组织和骨组织大面积缺损、伴有毁损性感染或根治性肿瘤切除的病例中，需要采取多学科方法来挽救肢体并进行功能康复。外科团队协作有助于降低肢体肿瘤学和创伤治疗中的截肢率、伤口愈合并发症以及二次手术的发生率。文中描述了合作手术概念的目标和局限性。未来，继续医学教育不仅将聚焦于适应症和技术，还将关注并发症管理、法医学问题以及因法律结构不适应导致的经济亏空。若引入清晰的临床路径来指导适应症、手术操作和术后治疗，可避免显著的经济亏空。过去，出于对患者的责任和伦理考量，催生了自愿性的跨学科治疗项目，而经济策略和越来越多的医疗事故诉讼将不可避免地在未来产生跨学科合作的新要求。
