Der Unfallchirurg
-
The somatic sequelae of accidents and violent events can vary from uninjured to fatal but the psychological impact can vary from integrity, to transient reactions up to severe and chronic trauma-related mental health disorders. In a dynamic interaction they determine the individual processing and coping in the aftermath, the mid-term and long-term outcome of medical treatment and of psychosocial rehabilitation. ⋯ A careful perception of early warning signals and basic skills of clinical management are required. When more specific psychodiagnostic and psychotherapeutic interventions seem necessary, mental health specialists have to be consulted within a staged care model.
-
Confrontation with aversive trauma symptoms is a key element in the treatment of stress-associated disorders, especially posttraumatic stress disorder. It is aimed at working through and reattributing aversive memories and situations. Various techniques enable confrontation in sensu (i.e. imagined) and in vivo (in reality). Confrontation techniques are highly effective; however, since there is a risk of temporarily enhanced, possibly previously suppressed traumatic memories, confrontation must be carefully prepared and revised.
-
The treatment of severely injured pregnant women places the highest demands on interdisciplinary cooperation in order to adequately account for maternal and fetal requirements. In the preclinical stage the mother must be optimally stabilized and treated. ⋯ In principle, all methods that are used in non-pregnant polytrauma patients should also be used without hesitation, especially in the initial routine diagnostics in order to establish the best treatment plan. The question of emergency delivery depends on the gestational age, the acute situation of the fetus and the mother as well as the risks resulting from the next therapeutic steps with respect to monitoring and intervention options in favor of the child.
-
Life-threatening injuries during pregnancy are a rare occurrence. The TraumaRegister DGU® (TR-DGU) has been recording whether seriously injured women were pregnant since 2016. This information is not sufficient to enable a differentiated assessment of the quality of care because parameters, such as gestational age, state of pregnancy at discharge and survival of the child are missing. The TraumaRegister working group of the committee on emergency medicine, intensive care and severe trauma management (section NIS) of the German Trauma Society (DGU) therefore came to the conclusion that the fetal outcome or the intactness of the pregnancy after acute treatment is an important measure of the quality of care of pregnant women. They commissioned a task force to work out a suitable data set for a better analysis of such cases. This article presents the so-called fetus module in detail. ⋯ The fetus module will provide important data to make the process and outcome quality of care of severely injured pregnant women measurable and to develop prognostic instruments with which predictions about high-risk constellations for the outcome of mother and child can be made.
-
Soft tissue reconstruction in aged patients is challenging. Free tissue transfer can be carried out in healthy patients with a high success rate despite old age. When free tissue transfer is contraindicated in multimorbid patients, local flaps are often chosen, which are associated with a high complication rate. Such salvage interventions must be selected so that an amputation is not disadvantageously influenced by the selection of the donor site or is even impossible. ⋯ If a local flap is to be used as a salvage surgery in an attempt to prevent a below the knee amputation in a patient who is not suitable for free tissue transfer, special emphasis must be placed on the donor site of this flap. The proximal dorsal aspects of the distal calf are required for covering a potential stump and should not be violated by harvesting a local flap.