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Postoperative Komplikationen in der plastischen Chirurgie

Postoperative complications in plastic surgery

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Zusammenfassung

Die plastische Chirurgie mit ihren vier Säulen, der rekonstruktiven, Hand-, Verbrennungs- und ästhetischen Chirurgie, behandelt neben Patienten mit primären Erkrankungen, wie erworbenen Defekten oder angeborenen Fehlbildungen, vor allem Patienten mit operativen und nichtoperativen (multimodalen) Therapiefolgen. Da in vielen Fällen plastisch-rekonstruktive Korrektureingriffe bzw. funktionelle und ästhetische Rekonstruktionen die einzigen noch zur Verfügung stehenden Behandlungsalternativen darstellen, kommt einem komplikationslosen Behandlungsverlauf höchste Bedeutung zu.

Das Patientengut der plastischen Chirurgie rekrutiert sich aus allen Altersgruppen beider Geschlechter, von Kleinkindern bis zu Patienten fortgeschrittenen Lebensalters. Dabei erstrecken sich die Indikationen in allen Altersgruppen von Traumafolgen über onkologische Folgezustände bis hin zu angeborenen Fehlbildungen bzw. Formstörungen.

Eine spezielle Herausforderung stellt die plastische Chirurgie des alten, multimorbiden und pathologisch adipösen Patienten dar. Zwar ist ein hohes Lebensalter über 70 Jahren per se noch nicht mit einer erhöhten eingriffsspezifischen Komplikationsrate verbunden, jedoch mit häufiger auftretenden medizinischen Problemen, wie es von dieser Altersgruppe generell zu erwarten ist. Risikofaktoren wie Alkoholismus und koronare Herzerkrankung erscheinen dabei eher als unabhängige Prädiktoren perioperativer Komplikationen. Somit können auch ältere und morbide Patienten bei entsprechendem Risiko- und Komplikationsmanagement von plastischen und wiederherstellenden Operationen profitieren.

Ein zeitgemäßes Komplikationsmanagement bei plastisch-chirurgischen Eingriffen beginnt bereits frühzeitig mit sorgfältiger Patientenselektion, Risikoeinschätzung und patientenadaptierter Auswahl geeigneter Behandlungsverfahren. Es erfordert daher neben dem primär sicheren Beherrschen des plastisch-operativen Spektrums vor allem Kenntnisse in konservativen und operativen Alternativmethoden, respektive Reserveverfahren, um chirurgisch-technische Zwischenfälle sowie Durchblutungs- und Wundheilungsstörungen sicher beherrschen zu können. Dieser Beitrag stellt diese spezifischen Aspekte des postoperativen Komplikationsmanagements in der plastischen Chirurgie dar.

Abstract

Plastic surgery covers a broad spectrum of diseases and conditions in the areas of reconstructive surgery, hand, burn and aesthetic surgery. Besides acquired defects or malformations an increasing number of patients are being treated for surgical or multimodal complications. In a considerable number of patients plastic and reconstructive surgery remains the only therapeutic alternative after other therapy has failed. Therefore complication management in plastic surgery is of utmost importance for a successful outcome.

In addition patient expectations in the results of plastic surgery as a discipline of invention and problem solving are steadily increasing. This challenge is reflected in clinical patient management by intensive research in tissue engineering and regenerative medicine.

Patients in plastic surgery are recruited from all age groups of either gender, involving traumatic and oncologic as well as congenital and aesthetic disorders. The demographics of aging, multimorbidity and obesity pose new challenges to plastic surgery.

Although age over 70 years is not an independent risk factor per se for complications in plastic surgery, e.g. for complex free flap transfer, medical problems are present at a higher rate, which is to be expected in this age group. Risk factors such as alcoholism and coronary heart diseases seem to be independent predictors of perioperative complications. Therefore older patients can also benefit from plastic surgery and recurrent operations by the corresponding risk and complication management.

Complication management necessitates careful patient selection, estimation of operative risks and patient-adapted selection of procedures. In addition to expertise in plastic surgery a thorough knowledge of non-surgical and surgical back-up procedures for technical incidents as well as vascular circulatory and wound healing disorders is required to deal successfully with complications in plastic surgery. This article presents these specific aspects of postoperative complication management in plastic surgery.

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  1. Klinik und Poliklinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    P.M. Vogt

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Vogt, P. Postoperative Komplikationen in der plastischen Chirurgie. Chirurg 80, 827–839 (2009). https://doi.org/10.1007/s00104-009-1689-9

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