Biehl Christoph, Biehl Lotta, Tarner Ingo Helmut, Müller-Ladner Ulf, Heiss Christian, Heinrich Martin
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen, 35392 Giessen, Germany.
Medical Faculty Heidelberg, Heidelberg University, 69117 Heidelberg, Germany.
Life (Basel). 2022 Jan 28;12(2):200. doi: 10.3390/life12020200.
Patients with an inflammatory disease frequently develop chronic angiopathy of the capillaries. Due to this pathology, there is an increased rate of complications in lower extremity surgical procedures. It is not uncommon for microangiopathic wound healing disorders to cause deep infections and fistulas, which lead to prolonged courses and hospitalizations. In addition, adhesions and ossifications of the contractile elements occur regularly. This sometimes results in serious limitations of the mobility of the patients. The study aims to present the results of a combination of vacuum and physical therapy.
A retrospective study of six patients with systemic sclerosis undergoing joint-related procedures of the lower extremity between 2015 and 2020 was performed. In addition to characterization of the patients and therapy, special attention was paid to cutaneous wound healing, affection of the fascia and displacement layers, and sclerosis of the muscle and tendon insertion.
The characterized structures (skin, tendon, fascia) show pathological changes at the microangiopathic level, which are associated with delayed healing and less physical capacity. Early suture removal regularly results in secondary scar dehiscence. With a stage-adapted vacuum therapy with sanitation of the deep structures and later on a dermal vacuum system, healing with simultaneous mobilization of the patients could be achieved in our patient cohort.
In the case of necessary interventions on the lower extremity, such as trauma surgery, additional decongestive measures in the sense of regular and sustained lymphatic therapy and adapted physiotherapy are indispensable.
炎症性疾病患者常发生毛细血管慢性血管病变。由于这种病理状况，下肢外科手术的并发症发生率增加。微血管性伤口愈合障碍导致深部感染和瘘管并不罕见，这会导致病程延长和住院时间延长。此外，收缩元件的粘连和骨化经常发生。这有时会导致患者活动严重受限。本研究旨在介绍负压与物理治疗相结合的结果。
对2015年至2020年间接受下肢关节相关手术的6例系统性硬化症患者进行回顾性研究。除了对患者和治疗方法进行描述外，还特别关注皮肤伤口愈合、筋膜和移位层的病变以及肌肉和肌腱附着处的硬化情况。
所描述的结构（皮肤、肌腱、筋膜）在微血管水平上显示出病理变化，这与愈合延迟和身体能力下降有关。早期拆线经常导致继发性瘢痕裂开。通过采用适应不同阶段的负压疗法对深部结构进行清创，随后使用真皮负压系统，我们的患者队列实现了愈合的同时患者的活动能力也得到了恢复。
在进行下肢必要干预（如创伤手术）时，定期且持续的淋巴治疗意义上的额外消肿措施以及适应性物理治疗是必不可少的。
