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Hintergrund: Fur jedes Krankenhaus und jede Klinik jeglicher Versorgungsstufen besteht unter steigendem Kostendruck der Zwang, wirtschaftlich arbeiten zu mussen, auch wenn die betriebswirtschaftliche Ausrichtung je nach Trager unterschiedlich ausgepragt ist. Nachfolgend soll am Beispiel der Behandlung von postoperativen Komplikationen eruiert werden, welche Auswirkungen sich dadurch auf die unternehmerische Praxis des Krankenhausbetriebes bilden. Wir fokussieren uns hier auf die Betrachtung der Opportunitatskosten, d. h. die dem Krankenhaus wegen der Behandlung eines Risikopatienten entgangenen Behandlungsmoglichkeiten anderer Patienten (und die aus diesen Behandlungen resultierendem Nutzungsausfall). Methode: Anhand postoperativer Infektionen des Mediastinums nach herzchirurgischen Eingriffen und den damit verbundenen Behandlungsmasnahmen soll modelltheoretisch eine Ermittlung von Opportunitatskosten durchgefuhrt werden. Basis der Betrachtungen ist der Betriebsabschluss des Mediclin Herzzentrums Lahr / Baden des Jahres 2008. Die Wundheilungsstorungen wurden aus dem Zeitraum 11 / 2004 bis 11 / 2007 erfasst und 3675 Patienten eingeschlossen, die in diesem Zeitintervall uber eine mediane Sternotomie operiert wurden. Betroffen waren 45 Patienten (1,2 %). Unterschiedliche Therapieoptionen stehen zur Verfugung. Im eigenen Vorgehen kommt ein Therapiealgorithmus zur Anwendung, der nach Stadium und Auspragung des Infektes die Behandlungsschritte vorgibt. Ergebnisse: Bei Kenntnis der oberen Grenzverweildauer, der mittleren Liegedauer, der mittleren Liegedauer der Mediastinitispatienten, dem mittleren Erlos und dem Wegfall des Zuschlages bei Uberschreiten der oberen Grenzverweildauer, alles Daten aus dem Jahresabschluss, und Kenntnis der tatsachlichen Verweildauer der Mediastinitispatienten lassen sich die Hohe der Opportunitatskosten bzw. eine mogliche Umsatzsteigerung errechnen. Die Reduzierung der mittleren Verweildauer der Patienten mit Mediastinitis von 48,43 Tagen auf z. B. 36,73 Tage ergabe eine mogliche Umsatzsteigerung von 10 633,41 €. Schlussfolgerungen: Patientensicherheit vorausgesetzt, lassen sich bei adaquater Planung erhebliche Umsatzsteigerungen verwirklichen. Diese Betrachtungen der Umsatzsituation lasst sich jedoch nur unter gleichen Bedingungen erreichen: Freie OP- und Bettenkapazitaten, vorhandene Personalressourcen, gleiche Sachkosten sowie ein ausreichendes Patientenaufkommen. Von Bedeutung fur die unternehmerische Praxis konnte die Betrachtung der Opportunitatskosten dann werden, wenn sich der Personalmangel weiter fortsetzt und hier nicht erweiterbare Kapazitaten im betriebswirtschaftlichen Sinne entstehen.

The surgical management of defects in the pelvic region is a great surgical challenge. Primary tumor recurrences have to be addressed and local infections require appropriate therapy such as rigorous debridement and antibiotic therapy. Plastic surgery provides tissue reconstruction by well perfused flaps and also reestablishment of anatomic structures in the ano-genital region. An early reconstruction also reduces the wound complications of adjuvant or post oncologic therapy and reduces the rate of wound healing problems.

UNLABELLED Moist wound treatment is a well recognized method for the treatment of aseptic acute and chronic wounds. While the moist environment is beneficial to the woundhealing process, it also increases the risk of bacterial superinfection. We here report on the results of a clinical phase-III-study in which we tested the effect of a new PVP-iodine liposomal hydrogel (Repithel) on split-thickness skin grafts. This formulation optimizes moist wound treatment by improving the cell proliferation rate while preventing wound infection. AIM The aim of this phase-III-study was to analyse the efficacy and tolerance of Repithel in patients receiving meshed skin grafts. METHODS 167 patients with transplantation wounds were either treated with lipid gauze alone (control group) or with lipid gauze and Repithel. In both groups the extent of neoepithelization, the frequency and severity of graft losses and the time until complete wound closure was achieved were determined. Analysis of the re-epithelization was achieved by photoplanimetry. Impedance measurements gave additional information on the regeneration of the epidermal barrier. RESULTS Wounds receiving Repithel showed a significantly faster neoepithelisation than wounds which were treated with lipid gauze alone. Treatment with Repithel significantly reduced both the number of graft losses and the size of area lost. The time until wounds were closed completely was significantly shorter in patients receiving Repithel than in controls. The positive effects of Repithel on wound healing were especially observed in smokers, patients with chronic wounds, burns or infected wounds. CONCLUSIONS Repithel supports healing of meshgraft transplants and reduces the risk of graft loss. Patients who heal poorly benefit particularly from the Repithel treatment.

Open fractures are complex injuries affecting the integrity of bones and adjacent soft tissue. The therapeutic goals in dealing with open fractures should consist of primary osteosynthesis in conjunction with functional reconstruction of soft tissue. In a period over 2 years, 26 patients were treated with extensive trauma in an interdisciplinary approach. These patients suffered from open fractures type 2 and 3. All patients were treated by primary osteosynthesis, and temporary wound closure with V.A.C.-system. Definitive wound closure was achieved by day 31 after injury. In contrast to a review of the pertinent literature we report the successful free tissue transfer in 21 patients during the critical period between 72 hours and several months preceded by the use of V.A.C.-system for the temporary coverage of open wounds.

BACKGROUND AND PURPOSE The Vacuum Assisted Closure device (V.A.C.) is commonly used for the treatment of problematic wounds. Furthermore, wound fluid can be easily collected with this device for research purposes. However, there is inadequate information as to whether the measurement of biomoieties of importance to wound healing is affected by the exposure of wound fluid to V.A.C. components, namely Polyurethane-foam and tubing. This study is an attempt to evaluate whether exposure of wound fluid to either V.A.C.-components affects concentrations of transforming growth factor beta 1 (TGF-b1) in wound fluid. MATERIAL AND METHOD Wound fluid was gathered from five decubital ulcer patients using the foil-technique and was exposed to sterile pieces of the V.A.C. Polyurethane-foam, tubing material or nothing for zero, one or five hours. Saline served as control. The concentration of TGF-b1 was measured using sandwich-ELISA. The resulting data were analyzed using two-way ANOVA, Newman-Keuls and Bonferroni t-Test. RESULTS The concentration of TGF-b1 decreased significant in all three groups during the five hours of the experiment (p < 0.05). There was no significant decrease in TGF-b1 concentration at any time point in-between the groups. CONCLUSION From this study, we conclude that wound-fluid collected from the V.A.C.-device via the polyurethane-foam or tubing for purposes of analyzing concentrations of TGF-beta 1 should not be different from fluid collected using the foil technique.