Osteomyelitis im Erwachsenenalter

Osteomyelitis in the adult is a rare disease. In this review we present the diagnostic and therapeutic principles for treatment of chronic osteomyelitis of long bones in adults. The most important step in treating osteomyelitis is the detection of the offending bacteria. The diagnostics should be performed with tissue and fluids from the depth of the wound. Superficial samples and swaps from fistulas should not be used to determine the offending bacteria. The defining criteria of chronic osteomyelitis are necrotic and non vascularized bony tissue. The appropriate therapy includes radical excision of the diseased bone and infected scar tissue, closure of the wound with well vascularized tissue including (muscle) flaps, stabilization of instable situations by external fixation and administration of adequate antibiotics. Remaining necrotic bone tissue is one of the most relevant sources for recurrent infection.     

Technische und digitale Weiterentwicklung in der laparoskopischen/offenen Chirurgie

Technological innovations have initiated a fundamental change in invasive therapeutic approaches which has led to a welcome reduction of surgical trauma but was also associated with a declining role of conventional surgery. Active utilization of future technological developments is decisive to promote new therapeutic strategies and to avoid a further loss of importance of surgery. This includes individualized preoperative therapy planning as well as intraoperative diagnostic work-up and navigation and the use of new functional intelligent implants. The working environment “surgical operating room” has to be refurbished into an integrated cooperating functional system. The impact of new technological developments is particularly obvious in minimally invasive surgery. There is a clear tendency towards further reduction in trauma in the surgical access. The incision will become smaller and the number of ports will be further reduced, with the aim of ultimately having just one port (monoport surgery) or even via natural access routes (scarless surgery). Among others, improved visualization including, e.g. autostereoscopy, digital image processing and intelligent support systems, which are able to assist in a cooperative way, will enable these goals to be achieved.     

Femoroazetabuläres Impingement bei Sportlern

Femoroacetabular impingement (FAI) and its therapy has gained importance in the last decade and several studies could show that if untreated it may lead to osteoarthritis of the hip joint. In this article an overview of the pathology of FAI, the diagnosis and treatment options are presented. A closer look is taken at the treatment of elite athletes regarding the different techniques. The first own clinical and radiological results of 91 patients treated by the arthroscopically-assisted anterior mini-open approach are presented with very good results and significant postoperative improvement regarding the hip injury and osteoarthritis outcome score (HOOS), the Western Ontario and McMasters University (WOMAC) osteoarthritis index and the University of California Los Angeles (UCLA) activity score, as well as alpha angle correction. This technique which is poorly represented in the literature can be used as a treatment option for FAI. The rehabilitation program is comparable to hip arthroscopy.     

Evidenzlage zur minimalinvasiven Chirurgie beim Ösophaguskarzinom

Surgery remains the mainstay of potentially curative treatment of esophageal cancer; however, esophageal resection is still associated with a relevant morbidity and mortality. Furthermore, patients frequently suffer from concomitant comorbidities and present in a reduced nutritional status. The rationale of minimally invasive surgery is the reduction of surgical trauma with subsequent minimization of (pulmonary) complications and mortality without compromising oncological quality. Minimally invasive esophageal resection was established nearly two decades ago and since then some centers worldwide have adopted this approach as the preferred option for surgical treatment of esophageal cancer. Minimally invasive esophageal resection can be safely performed and provides excellent results in experienced hands. Currently, there is only one randomized trial available comparing open and minimally invasive resection. It was demonstrated that the latter significantly reduced pulmonary complications with comparable mortality and oncological outcome. However, in the majority of studies these convincing results could not be confirmed. Reduced blood loss and a shortened hospital stay were shown to be the main advantages of the minimally invasive approach. Due to technical modifications, patient selection and a remarkable heterogeneity of current studies, a final conclusion on the value of minimally invasive esophagectomy is difficult to be drawn. Based on the current evidence, a noncritical use of minimally invasive resection for esophageal cancer cannot be recommended; however, in selected patients and with appropriate expertise this approach is at least comparable to open esophagectomy.