D Saul1, K Dresing2. 1. Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland. Dominik.Saul@med.uni-goettingen.de. 2. Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
Abstract
OBJECTIVE: Complete olecranon bursectomy with debridement, protection of veins and nerves. Risk-adapted antibiotic therapy and early functional aftercare. INDICATIONS: Acute, traumatic laceration of the bursa olecrani, chronic therapy-resistant bursitis olecrani. CONTRAINDICATIONS: For traumatic bursa injuries: general contraindications for anesthesia and surgery; chronic bursitis: initially not closable skin defect (plastic surgery required), hemodynamically instable patient (e.g. systemic inflammatory response syndrome [SIRS] or sepsis), pre-existing skin infection. SURGICAL TECHNIQUE: Local anesthesia beyond the lesion, careful debridement, identification and removal of the entire bursa, excision of contaminated skin, lavage, drain insertion (Redon, Easy-flow, Penrose). Wound closure, elastic bandage, and splint. POSTOPERATIVE MANAGEMENT: Elastic bandage for 2 days, followed by drain removal. Wound assessment, early functional aftercare without splint, antibiotic therapy in septic bursitis for 2 weeks, PRICE scheme. Removal of stitches after 10-12 days. RESULTS: Over 5 years, 138 cases of traumatic bursa lesion or chronic bursitis olecrani were treated in our clinic, 82 patients underwent surgery. Ten patients were treated with vacuum-assisted closure therapy and consecutive wound healing; fistulae occurred in two patients and in another two dehiscence developed. All of the defects could be closed without flaps.
OBJECTIVE: Complete olecranon bursectomy with debridement, protection of veins and nerves. Risk-adapted antibiotic therapy and early functional aftercare. INDICATIONS: Acute, traumatic laceration of the bursa olecrani, chronic therapy-resistant bursitis olecrani. CONTRAINDICATIONS: For traumatic bursa injuries: general contraindications for anesthesia and surgery; chronic bursitis: initially not closable skin defect (plastic surgery required), hemodynamically instable patient (e.g. systemic inflammatory response syndrome [SIRS] or sepsis), pre-existing skin infection. SURGICAL TECHNIQUE: Local anesthesia beyond the lesion, careful debridement, identification and removal of the entire bursa, excision of contaminated skin, lavage, drain insertion (Redon, Easy-flow, Penrose). Wound closure, elastic bandage, and splint. POSTOPERATIVE MANAGEMENT: Elastic bandage for 2 days, followed by drain removal. Wound assessment, early functional aftercare without splint, antibiotic therapy in septic bursitis for 2 weeks, PRICE scheme. Removal of stitches after 10-12 days. RESULTS: Over 5 years, 138 cases of traumatic bursa lesion or chronic bursitis olecrani were treated in our clinic, 82 patients underwent surgery. Ten patients were treated with vacuum-assisted closure therapy and consecutive wound healing; fistulae occurred in two patients and in another two dehiscence developed. All of the defects could be closed without flaps.
Authors: Sebastian F Baumbach; Christopher M Lobo; Ilias Badyine; Wolf Mutschler; Karl-Georg Kanz Journal: Arch Orthop Trauma Surg Date: 2013-12-05 Impact factor: 3.067