Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Häufige urologisch-sexualmedizinische Themen in der Praxis sind das Thema des MMW-Webinars am 5. Juni von 17.30 bis 19 Uhr. Konkret geht es um die Frage, wann bei Harnwegsinfektionen auf Antibiotika verzichtet werden kann, und um ein Update zur Therapie von Libido- und Potenzstörungen des Mannes. Der dritte Vortrag behandelt sexuell übertragbare Krankheiten. Stellen Sie Ihre Fragen an die Experten und sammeln Sie 2 CME-Punkte. Jetzt gleich anmelden!
Erweiterte Suche
Anmelden
nach oben
Aesthetic Plastic Surgery
Erschienen in: Aesthetic Plastic Surgery 3/2009

01.05.2009 | Original Article

Improving Outcomes in Autologous Breast Reconstruction

verfasst von: W. M. Rozen, M. W. Ashton

Erschienen in: Aesthetic Plastic Surgery | Ausgabe 3/2009

Einloggen, um Zugang zu erhalten

Abstract

Autologous breast reconstruction can often provide a more aesthetic outcome than other options for breast reconstruction because breast volume and shape can be extensively modified based on individual need, the texture of the reconstructed breast is a closer match to the native breast, and complications such as capsular contracture are avoided. However, with these benefits come the potential for complications unique to autologous tissue transfer. While overall complications are low, there are ways to maximize operative success and minimize the risk of complications. Deep inferior epigastric artery perforator (DIEP) flaps, the current mainstay in choice of autologous reconstruction, provide generally good outcomes. However, improvements in outcomes can still be achieved with a better understanding of individual anatomy. Perforator size, location, intramuscular and subcutaneous course, and association with motor nerves are all factors that can significantly affect operative technique, length of operation, and operative outcomes. With significant variation between individuals, preoperative imaging has become an essential element of DIEP flap surgery. Computed tomography angiography (CTA) is currently the gold standard but evolving techniques such as magnetic resonance angiography (MRA) and image-guided stereotaxy are rapidly contributing to improved outcomes.
Literatur
1.
Allen RJ, Treece P (1994) Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 32(1):32–38PubMedCrossRef
2.
Blondeel N, Vanderstraeten GG, Monstrey SJ, Van Landuyt K, Tonnard P, Lysens R, Boeckx WD, Matton G (1997) The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg 50(5):322–330PubMedCrossRef
3.
Blondeel PN (1999) One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 52(2):104–111PubMedCrossRef
4.
Gill PS, Hunt JP, Guerra AB, Dellacroce FJ, Sullivan SK, Boraski J, Metzinger SE, Dupin CL, Allen RJ (2004) A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg 113(4):1153–1160PubMedCrossRef
5.
Arnez ZM, Khan U, Pogorelec D, Planinsek F (1999) Rational selection of flaps from the abdomen in breast reconstruction to reduce donor site morbidity. Br J Plast Surg 52(5):351–354PubMedCrossRef
6.
Bajaj AK, Chevray PM, Chang DW (2006) Comparison of donor site complications and functional outcomes in free muscle-sparing TRAM flap and free DIEP flap breast reconstruction. Plast Reconstr Surg 117(3):737–746PubMedCrossRef
7.
Chen CM, Halvorson EG, Disa JJ, McCarthy C, Hu Q, Pusic AL, Cordeiro PG, Mehrara BJ (2007) Immediate postoperative complications in DIEP versus free/muscle-sparing TRAM flaps. Plast Reconstr Surg 120(6):1477–1482PubMedCrossRef
8.
Hofer SO, Damen TH, Mureau MA, Rakhorst HA, Roche NA (2007) A critical review of perioperative complications in 175 free deep inferior epigastric perforator flap breast reconstructions. Ann Plast Surg 59(2):137–142PubMedCrossRef
9.
Lindsey JT (2007) Integrating the DIEP and muscle-sparing (MS-2) free TRAM techniques optimizes surgical outcomes: presentation of an algorithm for microsurgical breast reconstruction based on perforator anatomy. Plast Reconstr Surg 119(1):18–27PubMedCrossRef
10.
Nahabedian MY, Dooley W, Singh N, Manson PN (2002) Contour abnormalities of the abdomen after breast reconstruction with abdominal flaps: the role of muscle preservation. Plast Reconstr Surg 109(1):91–101PubMedCrossRef
11.
Nahabedian MY, Manson PN (2002) Contour abnormalities of the abdomen after transverse rectus abdominis muscle flap breast reconstruction: a multifactorial analysis. Plast Reconstr Surg 109(1):81–87PubMedCrossRef
12.
Nahabedian MY, Momen B (2005) Lower abdominal bulge after deep inferior epigastric perforator flap (DIEP) breast reconstruction. Ann Plast Surg 54(2):124–129PubMedCrossRef
13.
Nahabedian MY, Momen B, Galdino G, Manson PN (2002) Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. Plast Reconstr Surg 110(2):466–475PubMedCrossRef
14.
Nahabedian MY, Tsangaris T, Momen B (2005) Breast reconstruction with the DIEP flap or the muscle-sparing (MS-2) free TRAM flap: is there a difference? Plast Reconstr Surg 115(2):436–444PubMedCrossRef
15.
Schaverien MV, Perks AG, McCulley SJ (2007) Comparison of outcomes and donor-site morbidity in unilateral free TRAM versus DIEP flap breast reconstruction. J Plast Reconstr Aesthet Surg 60(11):1219–1224PubMedCrossRef
16.
Tran NV, Buchel EW, Convery PA (2007) Microvascular complications of DIEP flaps. Plast Reconstr Surg 119(5):1397–1405PubMedCrossRef
17.
Zhong T, Lao A, Werstein MS, Downey DB, Evans HB (2006) High-frequency ultrasound: a useful tool for evaluating the abdominal wall following free TRAM and DIEP flap surgery. Plast Reconstr Surg 117(4):1113–1120PubMedCrossRef
18.
Hartrampf CR (1988) The transverse abdominal island flap for breast reconstruction. A 7-year experience. Clin Plast Surg 15(4):703–716PubMed
19.
Hartrampf CR, Scheflan M, Black PW (1982) Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 69(2):216–225PubMed
20.
Holmstrom H (1979) The free abdominoplasty flap and its use in breast reconstruction. Scand J Plast Reconstr Surg 13:423–429PubMedCrossRef
21.
Robbins TH (1979) Rectus abdominis myocutaneous flap for breast reconstruction. Aust N Z J Surg 49(5):527–530PubMedCrossRef
22.
Robbins TH (1981) Post-mastectomy breast reconstruction using a rectus abdominis musculocutaneous island flap. Br J Plast Surg 34(3):286–290PubMedCrossRef
23.
Koshima I, Moriguchi T, Soeda S, Tanaka H, Umeda N (1992) Free thin paraumbilical perforator-based flaps. Ann Plast Surg 29(1):12–17PubMedCrossRef
24.
Koshima I, Soeda S (1989) Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42(6):645–648PubMedCrossRef
25.
Onishi K, Maruyama Y (1986) Cutaneous and fascial vasculature around the rectus abdominis muscle: anatomic basis of abdominal fasciocutaneous flaps. J Reconstr Microsurg 2(4):247–253PubMedCrossRef
26.
Phillips TJ, Stella DL, Rozen WM, Ashton MW, Taylor GI (2008) Abdominal wall CT angiography: a detailed account of a newly established preoperative imaging technique. Radiology 249(1):32–44PubMedCrossRef
27.
Rozen WM, Ashton MW, Taylor GI (2008) Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat 21(2):89–98PubMedCrossRef
28.
Tansatit T, Chokrungvaranont P, Sanguansit P, Wanidchaphloi S (2006) Neurovascular anatomy of the deep inferior epigastric perforator flap for breast reconstruction. J Med Assoc Thai 89(10):1630–1640PubMed
29.
Boyd JB, Taylor GI, Corlett RJ (1984) The vascular territories of the superior epigastric and deep inferior epigastric systems. Plast Reconstr Surg 73(1):1–16PubMed
30.
Moon HK, Taylor GI (1988) The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg 82(5):815–829PubMed
31.
Taylor GI, Corlett RJ, Boyd JB (1983) The extended deep inferior epigastric flap: a clinical technique. Plast Reconstr Surg 72(6):751–765PubMed
32.
Taylor GI, Corlett RJ, Boyd JB (1984) The versatile deep inferior epigastric (inferior rectus abdominis) flap. Br J Plast Surg 37(3):330–350PubMedCrossRef
33.
Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body: Experimental study and clinical application. Br J Plast Surg 40(2):113–141PubMedCrossRef
34.
Taylor GI, Daniel RK (1975) The anatomy of several free flap donor sites. Plast Reconstr Surg 56(3):243–253PubMedCrossRef
35.
El-Mrakby HH, Milner RH (2002) The vascular anatomy of the lower anterior abdominal wall: a microdissection study on the deep inferior epigastric vessels and the perforator branches. Plast Reconstr Surg 109(2):539–543PubMedCrossRef
36.
Heitmann C, Felmerer G, Durmus C, Matejic B, Ingianni G (2000) Anatomical features of perforator blood vessels in the deep inferior epigastric perforator flap. Br J Plast Surg 53(3):205–208PubMedCrossRef
37.
Itoh Y, Arai K (1993) The deep inferior epigastric artery free skin flap: anatomic study and clinical application. Plast Reconstr Surg 91(5):853–863PubMed
38.
Kikuchi N, Murakami G, Kashiwa H, Homma K, Sato TJ, Ogino T (2001) Morphometrical study of the arterial perforators of the deep inferior epigastric perforator flap. Surg Radiol Anat 23(6):375–381PubMedCrossRef
39.
Milloy FJ, Anson BJ, McAfee DK (1960) The rectus abdominis muscle and the epigastric arteries. Surg Gynecol Obstet 110:293–302PubMed
40.
Munhoz AM, Ishida LH, Sturtz GP, Cunha MS, Montag E, Saito FL, Gemperli R, Ferreira MC (2004) Importance of lateral row perforator vessels in deep inferior epigastric perforator flap harvesting. Plast Reconstr Surg 113(2):517–524PubMedCrossRef
41.
Ohjimi H, Era K, Fujita T, Tanaka T, Yabuuchi R (2005) Analyzing the vascular architecture of the free TRAM flap using intraoperative ex vivo angiography. Plast Reconstr Surg 116(1):106–113PubMedCrossRef
42.
Ohjimi H, Era K, Tanahashi S, Kawano K, Manabe T, Naitoh M (2002) Ex vivo intraoperative angiography for rectus abdominis musculocutaneous free flaps. Plast Reconstr Surg 109(7):2247–2256PubMedCrossRef
43.
Rozen WM, Ashton MW, Pan WR, Taylor GI (2007) Raising perforator flaps for breast reconstruction: the intramuscular anatomy of the DIEA. Plast Reconstr Surg 120(6):1443–1449PubMedCrossRef
44.
Rozen WM, Ashton MW, Stella DL, Phillips TJ, Grinsell D, Taylor GI (2008) The accuracy of CT angiography for mapping the perforators of the DIEA: a blinded, prospective cohort study. Plast Reconstr Surg 122(4):1003–1009PubMedCrossRef
45.
Rozen WM, Ashton MW, Stella DL, Phillips TJ, Taylor GI (2008) The accuracy of CT angiography for mapping the perforators of the DIEA: a cadaveric study. Plast Reconstr Surg 122(2):363–369PubMedCrossRef
46.
Rozen WM, Palmer KP, Suami H, Pan WR, Ashton MW, Corlett RJ, Taylor GI (2008) The DIEA branching pattern and its relationship to perforators: the importance of preoperative CT angiography for DIEA perforator flaps. Plast Reconst Surg 121(2):367–373PubMedCrossRef
47.
Rozen WM, Ashton MW, Murray ACA, Taylor GI (2008) Avoiding denervation of rectus abdominis during DIEP flap harvest: the importance of medial row perforators. Plast Reconstr Surg 122(3):710–716PubMedCrossRef
48.
Bottero L, Lefaucheur JP, Fadhul S, Raulo Y, Collins ED, Lantieri L (2004) Electromyographic assessment of rectus abdominis muscle function after deep inferior epigastric perforator flap surgery. Plast Reconstr Surg 113(1):156–161PubMedCrossRef
49.
Duchateau J, Declety A, Lejour M (1988) Innervation of the rectus abdominis muscle: implications for rectus flaps. Plast Reconstr Surg 82(2):223–227PubMedCrossRef
50.
Galli A, Adami M, Berrino P, Leone S, Santi P (1992) Long-term evaluation of the abdominal wall competence after total and selective harvesting of the rectus abdominis muscle. Ann Plast Surg 28(5):409–413PubMedCrossRef
51.
Hammond DC, Larson DL, Severinac RN, Marcias M (1995) Rectus abdominis muscle innervation: implications for TRAM flap elevation. Plast Reconstr Surg 96(1):105–110PubMedCrossRef
52.
Rozen WM, Ashton MW, Taylor GI (2008) Refining the course of the thoracolumbar nerves: a new understanding of the innervation of the anterior abdominal wall. Clin Anat 21(4):325–333PubMedCrossRef
53.
Rozen WM, Kiil BJ, Ashton MW, Grinsell D, Seneviratne S, Taylor GI (2008) Avoiding denervation of rectus abdominis during DIEP flap harvest II: an intraoperative assessment of the nerves to rectus. Plast Reconstr Surg 122(5):1321–1325PubMedCrossRef
54.
Taylor GI, Doyle M, McCarten G (1990) The Doppler probe for planning flaps: anatomical study and clinical applications. Br J Plast Surg 43(1):1–16PubMedCrossRef
55.
Blondeel PN, Beyens G, Vergaeghe R, Van Landuyt K, Tonnard P, Monstrey SJ, Matton G (1998) Doppler flowmetry in the planning of perforator flaps. Br J Plast Surg 51(3):202–209PubMedCrossRef
56.
Giunta RE, Geisweid A, Feller AM (2000) The value of preoperative Doppler sonography for planning free perforator flaps. Plast Reconstr Surg 105(7):2381–2386PubMedCrossRef
57.
Hallock GG (2003) Doppler sonography and colour duplex imaging for planning a perforator flap. Clin Plast Surg 30(3):347–357PubMedCrossRef
58.
Hallock GG (1994) Evaluation of fasciocutaneous perforators using color duplex imaging. Plast Reconstr Surg 94(5):644–651PubMedCrossRef
59.
Rozen WM, Phillips TJ, Ashton MW, Stella DL, Gibson RN, Taylor GI (2008) Preoperative imaging for DIEA perforator flaps: a comparative study of computed tomographic angiography and Doppler ultrasound. Plast Reconstr Surg 121(1):9–16PubMed
60.
Bluemke DA, Chambers TP (1995) Spiral CT angiography: an alternative to conventional angiography. Radiology 195(2):317–319PubMed
61.
Chow LC, Napoli A, Klein MB, Chang J, Rubin GD (2005) Vascular mapping of the leg with multi-detector row CT angiography prior to free-flap transplantation. Radiology 237(1):353–360PubMedCrossRef
62.
Karanas YL, Antony A, Rubin G, Chang J (2004) Preoperative CT angiography for free fibula transfer. Microsurgery 24(2):125–127PubMedCrossRef
63.
Nagler RM, Braun J, Daitzman M, Laufer D (1997) Spiral CT angiography: an alternative vascular evaluation technique for head and neck microvascular reconstruction. Plast Reconstr Surg 100(7):1697–1702PubMedCrossRef
64.
Rieker O, Duber C, Schmiedt W, Von Zitzewitz H, Schweden F, Thelen M (1996) Prospective comparison of CT angiography of the legs with intraarterial digital subtraction angiography. AJR Am J Roentgenol 166:269–276PubMed
65.
Alonso-Burgos A, Garcia-Tutor E, Bastarrika G, Cano D, Martinez-Cuesta A, Pina LJ (2006) Preoperative planning of deep inferior epigastric artery perforator flap reconstruction with multi-slice-CT angiography: imaging findings and initial experience. J Plast Reconstr Aesthet Surg 59(6):585–593PubMedCrossRef
66.
Fishman EK (2001) CT angiography: clinical applications in the abdomen. Radiographics 21:S3–S16PubMed
67.
Masia J, Clavero JA, Larranaga JR, Alomar X, Pons G, Serret P (2006) Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstr Aesthet Surg 59(6):594–599PubMedCrossRef
68.
Masia J, Larranaga JR, Clavero JA, Vives L, Pons G, Pons JM (2008) The value of the multidetector row computed tomography for the preoperative planning of deep inferior epigastric artery perforator flap. Ann Plast Surg 60(1):29–36PubMedCrossRef
69.
Rosson GD, Williams CG, Fishman EK, Singh NK (2007) 3D CT angiography of abdominal wall vascular perforators to plan DIEAP flaps. Microsurgery 27(8):641–646PubMedCrossRef
70.
Rozen WM, Anavekar NS, Ashton MW, Stella DL, Grinsell D, Bloom R, Taylor GI (2008) Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction? Microsurgery 28(7):516–523PubMedCrossRef
71.
Rozen WM, Ashton MW, Grinsell D, Stella DL, Phillips TJ, Taylor GI (2008) Establishing the case for CT angiography in the preoperative imaging of perforators for DIEA perforator flaps. Microsurgery 28(5):227–232PubMedCrossRef
72.
Rozen WM, Phillips TJ, Ashton MW, Stella DL, Taylor GI (2008) A new preoperative imaging modality for free flaps in breast reconstruction: computed tomographic angiography. Plast Reconstr Surg 122(1):38e–40ePubMedCrossRef
73.
Rozen WM, Stella DL, Ashton MW, Phillips TJ, Taylor GI (2007) Three-dimensional CT angiography: a new technique for imaging microvascular anatomy. Clin Anat 20(8):1001–1003PubMedCrossRef
74.
Rozen WM, Stella DL, Ashton MW, Phillips TJ, Taylor GI (2008) The cutaneous arteries of the anterior abdominal wall: a three-dimensional study. Plast Reconstr Surg 121(4):1510–1512PubMedCrossRef
75.
Rozen WM, Murray AC, Ashton MW, Bloom R, Stella DL, Phillips TJ, Taylor GI (2008) The cutaneous course of deep inferior epigastric perforators: implications for flap thinning. J Plast Reconstr Aesthet Surg
76.
Ahn CY, Narayanan K, Shaw WW (1994) In vivo anatomic study of cutaneous perforators in free flaps using magnetic resonance imaging. J Reconstr Microsurg 10:157–163PubMedCrossRef
77.
Rozen WM, Stella DL, Phillips TJ, Ashton MW, Corlett RJ, Taylor GI (2007) Magnetic resonance angiography in the preoperative planning of DIEA perforator flaps. Plast Reconstr Surg, in press
78.
Rozen WM, Murray ACA, Ashton MW, Bloom R, Stella DL, Phillips TJ, Taylor GI (2007) Improving operative outcome in DIEP flap breast reconstruction: radiological advances for preoperative imaging of the abdominal wall. 4th European Conference of Plastic and Reconstructive Surgery of the Breast, December 2007, Milan, Italy
79.
Alonso-Burgos A, Garcia-Tutor E (2008) Clinical experience in MR angiography in DIEP and perforator flaps. 2nd international course on planning DIEP and perforator flaps with 3D angio-CT and angio-MR, April 2008, Pamplona, Navarra, Spain
80.
Perks AG, Neil-Dwyer JG, Ludman C, Mcculley SJ (2008) Contrast enhanced magnetic resonance angiography in preoperative planning for DIEP flap elevation. Royal Australasian College of Surgeons Annual Scientific Congress, May 2008, Hong Kong
81.
Barnett GH, Miller DW, Weisenberger J (1999) Frameless stereotaxy with scalp-applied fiducial markers for brain biopsy procedures: experience in 218 cases. J Neurosurg 91(4):569–576PubMedCrossRef
82.
Klimek L, Mösges R, Schlöndorff G, Mann W (1998) Development of computer-aided surgery for otorhinolaryngology. Comput Aided Surg 3(4):194–201PubMedCrossRef
83.
McInerney J, Roberts DW (2000) Frameless stereotaxy of the brain. Mt Sinai J Med 67(4):300–310PubMed
84.
Paleologos TS, Wadley JP, Kitchen ND, Thomas DG (2000) Clinical utility and cost-effectiveness of interactive image-guided craniotomy: clinical comparison between conventional and image-guided meningioma surgery. Neurosurgery 47(1):40–47PubMedCrossRef
85.
Papadopoulos EC, Girardi FP, Sama A, Sandhu HS, Cammisa FP (2005) Accuracy of single-time, multilevel registration in image-guided spinal surgery. Spine J 5(3):263–267PubMedCrossRef
86.
Spivak CJ, Pirouzmand F (2005) Comparison of the reliability of brain lesion localization when using traditional and stereotactic image-guided techniques: a prospective study. J Neurosurg 103(3):424–427PubMedCrossRef
87.
Rozen WM, Ashton MW, Stella DL, Phillips TJ, Taylor GI (2008) Stereotactic image-guided navigation in the preoperative imaging of perforators for DIEP flap breast reconstruction. Microsurgery 28(6):417–423PubMedCrossRef
Metadaten
Titel
Improving Outcomes in Autologous Breast Reconstruction
verfasst von
W. M. Rozen
M. W. Ashton
Publikationsdatum
01.05.2009
Verlag
Springer-Verlag
Erschienen in
Aesthetic Plastic Surgery / Ausgabe 3/2009
Print ISSN: 0364-216X
Elektronische ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-008-9272-1

Weitere Artikel der Ausgabe 3/2009

Aesthetic Plastic Surgery 3/2009 Zur Ausgabe

Editorial

“The Best of Europe”: Abstracts from the 1st EASAPS Meeting, Madrid, Spain, 2008

Original Article

Characteristics of Refractory Sweating Areas Following Minimally Invasive Surgery for Axillary Hyperhidrosis

Review

Body Shaping and Volume Restoration: The Role of Hyaluronic Acid

Letter to the Editor

Sad Umbilicus: Prevention and Treatment

Original Article

Sonication of Removed Breast Implants for Improved Detection of Subclinical Infection

Original Article

Safety and Effectiveness of Mentor’s MemoryGel Implants at 6 Years

Neu im Fachgebiet Chirurgie

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

21.05.2024 TAVI Nachrichten

Bei schwerer Aortenstenose und obstruktiver KHK empfehlen die Leitlinien derzeit eine chirurgische Kombi-Behandlung aus Klappenersatz plus Bypass-OP. Diese Empfehlung wird allerdings jetzt durch eine aktuelle Studie infrage gestellt – mit überraschender Deutlichkeit.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.
Bildnachweise