Haas E M, Volkmer E, Holzbach T, Wallmichrath J, Engelhardt T O, Giunta R E
Handchirurgie, Plastische Chirurgie, Äshetische Chirurgie, Klinikum der Ludwig-Maximilians Universität München, München.
Handchir Mikrochir Plast Chir. 2013 Dec;45(6):318-22. doi: 10.1055/s-0033-1357197. Epub 2013 Dec 19.
Severe hand traumata have a significant impact on our health system and on insurance companies, respectively. It is estimated that 33% of all occupational injuries and 9% of all invalidity pensions are due to severe hand trauma. Unfortunately, these high numbers are not only due to the severity of the trauma but to organisational deficiencies. Usually, the patient is treated at the general surgical emergency in the first place and only then forwarded to a microsurgeon. This redirection increases the time that is required for the patient to finally arrive at an expert for hand surgery. On the one hand, this problem can be explained by the population's lack of awareness for distinguished experts for hand and microsurgery, on the other hand, the emergency network, or emergency doctors in particular are not well informed about where to take a patient with a severe hand trauma - clearly a problem of communication between the hospitals and the ambulance. It is possible to tackle this problem, but put participating hand trauma centres have to work hand in hand as a network and thus exploit synergy effects. The French system "FESUM" is a good example for such a network and even comprises centres in Belgium and Switzerland. To improve the treatment of severe hand trauma, a similar alliance was initiated in Germany just recently. The pilot project "Hand Trauma Alliance" (www.handverletzung.com) was started in April 2013 and currently comprises two hospitals within the region of upper Bavaria. The network provides hand trauma replantation service on a 24/7 basis and aims at shortening the way from the accident site to the fully qualified hand surgeon, to improve the therapy of severe hand injuries and to optimise acute patient care in general. In order to further increase the alliance's impact it is intended to extend the project's scope from regional to national coverage - nevertheless, such an endeavour can only be done in collaboration with the German Society for Hand Surgery (DGH). This article comprises 2 parts. First, the state-of-the-art of acute severe hand trauma care is summarised and explained. Subsequently, the above-mentioned pilot project is described in every detail, including positive effects but also barriers that still have to be overcome.
严重手部创伤分别对我们的医疗系统和保险公司产生重大影响。据估计，所有职业伤害中有33%以及所有伤残抚恤金中有9%是由严重手部创伤所致。不幸的是，这些高比例不仅归因于创伤的严重性，还归因于组织缺陷。通常，患者首先在普通外科急诊接受治疗，然后才被转至显微外科医生处。这种转诊增加了患者最终找到手外科专家所需的时间。一方面，这个问题可以解释为民众对手部和显微外科杰出专家缺乏认识，另一方面，急诊网络，尤其是急诊医生，对严重手部创伤患者应送往何处了解不足——这显然是医院与救护车之间的沟通问题。解决这个问题是有可能的，但参与其中的手部创伤中心必须作为一个网络携手合作，从而发挥协同效应。法国的“FESUM”系统就是这样一个网络的典范，甚至还包括比利时和瑞士的中心。为改善严重手部创伤的治疗，德国最近也启动了类似的联盟。“手部创伤联盟”试点项目（www.handverletzung.com）于2013年4月启动，目前包括上巴伐利亚地区的两家医院。该网络提供全天候的手部创伤再植服务，旨在缩短从事故现场到合格手外科医生的路程，改善严重手部损伤的治疗，并总体优化急性患者护理。为进一步扩大该联盟的影响力，计划将项目范围从地区扩大到全国范围——然而，这样的努力只能与德国手外科学会（DGH）合作进行。本文分为两部分。首先，总结并解释急性严重手部创伤护理的现状。随后，详细描述上述试点项目，包括积极影响以及仍需克服的障碍。
