{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T08:37:37Z","timestamp":1782463057623,"version":"3.54.5"},"reference-count":52,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zentralbl Chir"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Das schwere Thoraxtrauma kann einerseits als penetrierende oder stumpfe Monoverletzung oder im Rahmen einer Polytraumatisierung auftreten. Bei der H\u00e4lfte der im TraumaRegister DGU dokumentierten Schwerverletzten ist ein schweres Thoraxtrauma, definiert nach Abbreviated Injury Scale (AIS) mit \u2265\u00a03, diagnostiziert worden. Im eigenen Kollektiv betrug der Anteil 60%. Die Notfallthorakotomie im Schockraum oder innerhalb der 1. Stunde nach Aufnahme ist in Deutschland mit 0,9% der schweren Thoraxverletzungen eine \u00e4u\u00dferst seltene Intervention. Das differenzierte Management von komplexen Polytraumata und umfangreichen pathophysiologischen Reaktionen auf die Traumatisierung haben ebenso wie das Wissen \u00fcber die Entstehung von Sekund\u00e4rschaden dazu gef\u00fchrt, dass durch minimalinvasive Verfahren wie videoassistierte Thorakoskopien (VATS) oder das Einlegen einer Thoraxdrainage der Gro\u00dfteil der schweren Thoraxverletzungen erfolgreich therapiert werden kann. Dabei sind penetrierende\n          Verletzungen des Thorax mit &lt;\u00a04% eine Seltenheit. Mit steigender Tendenz weisen unter den stumpfen Thoraxverletzungen &gt;\u00a06% eine instabile Thoraxwand auf, die einer operativen Rekonstruktion bedarf. Die demografische Entwicklung in Deutschland f\u00fchrt dazu, dass zunehmend auch Niedrigenergietraumata zu h\u00f6hergradigen Thoraxwandverletzungen mit penetrierenden Rippenfrakturen in Pleura, Lunge, Peri- bzw. Myokard und Zwerchfell f\u00fchren. Eine Thoraxwandinstabilit\u00e4t mit hochgradiger Einschr\u00e4nkung der Atemmechanik kann zu fulminanten Pneumonien bis hin zum ARDS (Acute Respiratory Distress Syndrome) f\u00fchren. In der vergangenen Dekade hat vor diesem Hintergrund die operative Thoraxwandrekonstruktion stark an Bedeutung gewonnen. Auf der Grundlage der \u00fcberzeugenden Evidenz ist die klinische Beurteilung des Umfangs und der Schwere des Traumas und der Grad der atemmechanischen Einschr\u00e4nkung die Basis f\u00fcr eine strukturierte Entscheidung \u00fcber eine nicht operative oder\n          operativ-rekonstruktive Strategie sowie den OP-Zeitpunkt, die OP-Art und den OP-Umfang. Durch die fr\u00fchzeitige OP innerhalb von 72\u00a0h k\u00f6nnen Morbidit\u00e4t (Pneumonierate, Intensivliegedauer und Beatmungsdauer) sowie Letalit\u00e4t verringert werden. In dem folgenden Artikel werden evidenzbasierte Algorithmen zur operativen und nicht operativen Versorgungsstrategie von schweren Thoraxverletzungen diskutiert. Dazu wurden in einer selektiven Literaturrecherche die wegweisenden Ver\u00f6ffentlichungen zu Indikationsstellung, Versorgungsstrategie und Therapieempfehlungen der schweren Thoraxverletzung sowie Thoraxwandrekonstruktion eingeschlossen.<\/jats:p>","DOI":"10.1055\/a-2348-0638","type":"journal-article","created":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T22:32:20Z","timestamp":1723069940000},"page":"368-377","source":"Crossref","is-referenced-by-count":6,"title":["Das schwere Thoraxtrauma: Indikationen und Kontraindikationen f\u00fcr operative und nicht operative Versorgungsstrategien"],"prefix":"10.1055","volume":"149","author":[{"given":"Christopher","family":"Spering","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center G\u00f6ttingen, G\u00f6ttingen, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Lehmann","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center G\u00f6ttingen, G\u00f6ttingen, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,8,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1097\/00005373-200112000-00013","article-title":"Pulmonary tractotomy versus lung resection: viable options in penetrating lung injury","volume":"51","author":"M Gasparri","year":"2001","journal-title":"J Trauma"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1007\/s10049-003-0607-9","article-title":"Thoraxtrauma und Thoraxdrainage: Diagnostik und Therapie. 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