Tautenhahn J, Bürger T, Lippert H
Klinik für Allgemein-, Viszeral- und Gefässchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg.
Chirurg. 2004 May;75(5):492-7. doi: 10.1007/s00104-004-0844-6.
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 in the future will inevitably produce new imperatives for interdisciplinary cooperation.
在创伤后软组织和骨质大面积缺损、存在毁损性感染或进行根治性肿瘤切除的情况下，需要采取多学科方法来挽救肢体并实现功能康复。手术团队协作有助于降低肢体肿瘤学和创伤治疗中的截肢率、伤口愈合并发症及二次手术率。文中描述了合作手术理念的目标和局限性。未来，继续医学教育不仅将关注适应证和技术，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。如果引入清晰的临床路径来指导适应证、手术操作和术后治疗，就可以避免显著的经济亏空。过去，对患者的责任和伦理考量促成了自愿性跨学科治疗项目的发展，而未来的经济策略和越来越多的医疗事故诉讼将不可避免地为跨学科合作带来新的要求。
