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ABSTRACT: Infektionen am diabetisch neuropathischen Fuß sind die typischen Komplikationen der Fußulzera. Sie stellen ein erhebliches
Risiko zum Verlust des Fußes bzw. zur Sepsis dar, deshalb sind umfangreiche konservative und operative Maßnahmen zur Vermeidung
und zur Heilung der Ulzera erforderlich. Wenn Infektionen eingetreten sind, erfordern sie ein gezieltes Vorgehen zunächst
mit Entlastung und Antibiotikagabe. Abszesse und Phlegmonen lassen sich durch klinischen Befund, Sonographie, Röntgenaufnahme,
Computer- (CT) und Magnetresonanztomographie (MRT) lokalisieren. Sie müssen durch Inzisionen drainiert werden. Nach Abklingen
des akuten Stadiums werden die infizierten Nekrosen an Knochen und Weichteilen durch Débridements entfernt. Die Hautdefekte
sind durch geeignete Verfahren zu verschließen. Störende Fehlstellungen und Instabilitäten sind durch Korrekturen an den Sehnen,
durch Knochenresektionen oder durch Fusionsoperationen zu beseitigen. Auf diese Weise lässt sich eine Vielzahl von Amputationen
verhindern bzw. das Ausmaß der Amputation deutlich einschränken.
Infections are the typical complications of ulcers related to the neuropathic diabetic foot. The loss of the foot or sepsis
is the consequence due to the progression of an untreated infection. Therefore, prophylaxis of ulcer formation is the key
to lower the rate of amputation. If infection has occurred antibiotics and non-weight bearing are indicated. Abscesses and
phlegmons can be localized by the clinical findings, ultrasound, x-rays, computer tomography and MRI and immediate surgical
treatment is necessary to prevent further spreading. In the chronic phase dead tissue, necrotic tendons and bones need to
be resected. Closure of the skin can be achieved by secondary healing or other methods of plastic surgery. Persistent bony
prominences have to be removed and instabilities need fusion operations. In this way many amputations can be avoided or the
extent of amputation can be noticeably reduced.
Der Orthopäde 05/2012; 38(12):1215-1221. · 0.51 Impact Factor
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ABSTRACT: Die diabetisch-neuropathische Osteoarthropathie (DNOAP, Charcot-Arthropathie) ist gekennzeichnet durch eine Destruktion des
Fußskeletts mit Frakturen und Gelenkluxationen. Die Therapie des akuten Charcot-Fußes ist primär konservativ. Eine operative
Therapie ist bei instabilen, konservativ nicht versorgbaren Fußdeformitäten, der DNOAP des Rückfußes und bei tiefen Infektionen
indiziert. Die Komplikationsrate liegt bei den offenen Verfahren zwischen 10 und 20%. Wir stellen ein minimalinvasives Verfahren
mit geschlossener Reposition eines akut eingebrochenen Charcot-Fußes unter Anwendung eines Ringfixateurs vor.
Diabetic neuropathic osteo-arthropathy (DNOAP; Charcot arthropathy) is a progressive disease characterized by joint luxation,
fractures and excessive destruction of foot architecture. The operative therapy is indicated when conservative therapy fails,
in progressive breakdown, in hindfoot Charcot and in spreading infections due to plantar ulcers. The complication rate of
10–20% in open surgery is high. We present a minimally invasive technique of closed reduction and application of a ring fixator
for reconstruction of the foot architecture and arthrodesis of the involved joints.
SchlüsselwörterCharcot-Fuß-Charcot-Arthropathie-Diabetisch-neuropathische Osteoarthropathie (DNOAP)-Arthrodese-Ringfixateur
KeywordsCharcot foot-Charcot arthropathy-Diabetic neuropathic osteo-arthropathy (DNOAP)-Arthrodesis-Ring fixator
Der Unfallchirurg 04/2012; 113(7):594-597. · 0.61 Impact Factor
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ABSTRACT: Diabetic neuropathic osteo-arthropathy (DNOAP; Charcot arthropathy) is a progressive disease characterized by joint luxation, fractures and excessive destruction of foot architecture. The operative therapy is indicated when conservative therapy fails, in progressive breakdown, in hindfoot Charcot and in spreading infections due to plantar ulcers. The complication rate of 10-20% in open surgery is high. We present a minimally invasive technique of closed reduction and application of a ring fixator for reconstruction of the foot architecture and arthrodesis of the involved joints.
Der Unfallchirurg 07/2010; 113(7):594-7. · 0.61 Impact Factor
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ABSTRACT: Infections are the typical complications of ulcers related to the neuropathic diabetic foot. The loss of the foot or sepsis is the consequence due to the progression of an untreated infection. Therefore, prophylaxis of ulcer formation is the key to lower the rate of amputation. If infection has occurred antibiotics and non-weight bearing are indicated. Abscesses and phlegmons can be localized by the clinical findings, ultrasound, x-rays, computer tomography and MRI and immediate surgical treatment is necessary to prevent further spreading. In the chronic phase dead tissue, necrotic tendons and bones need to be resected. Closure of the skin can be achieved by secondary healing or other methods of plastic surgery. Persistent bony prominences have to be removed and instabilities need fusion operations. In this way many amputations can be avoided or the extent of amputation can be noticeably reduced.
Der Orthopäde 11/2009; 38(12):1215-21. · 0.51 Impact Factor
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MMW Fortschritte der Medizin 04/2009; 151(10):37.
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ABSTRACT: A good number of infections requiring only minor surgery can be treated in the GP's office, simply and adequately. Of importance, however, is the physician's ability to recognize when a patient needs to be referred to a specialist. Provided the principles listed here are adhered to, treatment is usually successful. All other courses indicate a multifactorial pathology and belong in the hands of an experienced specialist.
MMW Fortschritte der Medizin 04/2007; 149(10):27-30.
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ABSTRACT: Uncomplicated wounds can be treated immediately in the general practitioner's office. Management by a specialist is necessary only in the case of wounds involving the eyes, nose or mouth, or in the presence of other unusual features.
MMW Fortschritte der Medizin 04/2007; 149(10):36-7.
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ABSTRACT: Vasculitis can lead to skin necrosis, which typically shows decayed recovery tendency and is able to lead to local as well as systemic inflammation. By repeated necrosectomy, vacuum therapy, split skin graft transplantation as well as simultaneous immunosuppression and systemic antibiotics, the cutaneous manifestations of vasculitis where cured.
Zentralblatt für Chirurgie 06/2004; 129 Suppl 1:S89-91. · 1.02 Impact Factor
