Therapeutische Umschau. Revue thérapeutique
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In the last 15 years the Fast Track Concept or Enhanced Recovery after Surgery (ERAS) as a clinical pathway for improving perioperative care, maintaining physiological functions, reducing intraoperative stress and shortening the length of hospital stay, has become more common in colorectal surgery. After first promising results in prospective studies an expert group developed recommendations of a modified, multimodal Fast Track Concept in 2009. Main elements in this concept are laparoscopy, no nasogastric tubes, perioperative peridural anaesthesia and quick mobilisation of the patient after surgery. ⋯ Furthermore the Fast Track Concept constitutes a challenge for the interdisciplinary collaboration of all involved treatment groups. Especially the postoperative outpatient treatment remains a problem due to unavailable rehabilitation capacities or ambulant care. Therefore a proper preoperative planning of the Fast Track Concept and the outpatient care should be performed interdisciplinary by the surgeons and the general practitioners.
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Aiming at primary wound healing, the majority of surgical interventions end with a wound closure. The wound edges are brought together and secured using sutures, staples or glue, respectively. A common surgical wound therefore tends to undergo an orderly and timely repair process with the result of sustained restored anatomic and functional integrity. ⋯ In the last two decades, negative-pressure wound therapy has been one of the major innovations in wound care. In addition to acting as an occlusive dressing, it may increase blood flow to the wound site, decrease edema, decrease bacterial contamination, and promote wound contraction. Further strategies to enhance wound healing or scar formation still under investigation include growth factors or regenerative cell therapy.