Der Unfallchirurg
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Bone substitutes are used to supplement or substitute autogenous transplantation of cancellous bone. These materials should provide a scaffold structure and support bone healing alone or in combination with other substances. ⋯ Moreover, biomaterials can be stored, also ensuring ready availability. This educational article gives an overview of bone substitutes currently in clinical use.
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Severe intraoperative bleeding may endanger the patient's life, necessitate additional human resources and increase perioperative costs. The aetiology of perioperative coagulopathy is complex and consists of depletion, consumption and dilution of clotting factors and thrombocytes. Cofactors like hypothermia, acidosis and severe anaemia may aggravate coagulopathy. ⋯ Evaluation of the clinical bleeding situation and coagulation tests, in particular point-of-care testing like thrombelastography, should be used to guide and control the therapeutic strategy. Fresh frozen plasma, concentrates of clotting factors, platelet concentrates and antifibrinolytic drugs are available for therapy of perioperative coagulopathy. To obtain optimal benefit for the patient, these products should be applied based on a therapeutic algorithm.