Reiter G, Weil F, Thomas B, Kühner C, Wittenberg G, Schäfer A, Grützner P A, Kneser U
Klinik für Unfallchirurgie und Orthopädie, Sektion für Septische Chirurgie, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, Ludwigshafen, Deutschland.
Klinik für Hand, Plastische und Rekonstruktive Chirurgie, - Schwerbrandverletztenzentrum - BG Unfallklinik Ludwigshafen; Klinik für Plastische und Handchirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland.
Chirurg. 2019 Oct;90(10):795-805. doi: 10.1007/s00104-019-01022-8.
Complex injuries of the lower extremities in geriatric patients with multiple pre-existing comorbidities represent an increasing challenge to an interdisciplinary team of surgeons. Functional reconstruction of the extremity through osteosynthesis, revascularization and defect coverage aims to preserve mobility and achieve an early return to activities of daily life at home, while avoiding major amputation and the associated risks regarding morbidity and mortality. An interdisciplinary assessment of geriatric patients regarding dystrophy of soft tissue and skín, cardiovascular and metabolic comorbidities as well as specific geriatric diagnostics are crucial steps in ensuring favorable outcomes. Perioperatively, all improvable risk factors should be actively optimized and a specialized interdisciplinary approach to treatment planning (extremity board) is absolutely necessary for success of treatment. It outlines the special features of the geriatric assessment, diagnostics, perioperative management and treatment targets.
患有多种并存疾病的老年患者下肢复杂损伤，对外科医生跨学科团队来说是日益严峻的挑战。通过骨固定、血管重建和缺损覆盖进行肢体功能重建，旨在保持活动能力并早日恢复家庭日常生活活动，同时避免大截肢以及相关的发病和死亡风险。对老年患者进行关于软组织和皮肤营养不良、心血管和代谢并存疾病以及特定老年诊断的跨学科评估，是确保取得良好结果的关键步骤。围手术期，所有可改善的风险因素都应积极优化，采用专门的跨学科治疗计划方法（肢体委员会）对治疗成功绝对必要。它概述了老年评估、诊断、围手术期管理和治疗目标的特殊特征。
