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Korrekturmöglichkeiten der gestörten Wundheilung

Possible interventions in impaired wound healing

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Zusammenfassung

Chronische Wunden haben unterschiedliche Ursachen, daher ist die Evaluation der zugrunde liegenden Erkrankung und deren Therapie die erste Säule eines umfassenden Wundheilungskonzeptes. Die Behandlung der lokalen (z. B. Wundinfektion, Nekrosen, Fremdkörper) und systemischen (z. B. Diabetes, Immunsuppression, Patientencompliance) Störfaktoren ist eine weitere Säule des Konzeptes. Schließlich gilt es aus der anergen und nicht heilenden Wunde eine saubere und aktive Wunde zu schaffen. Die dritte Säule der Wundbehandlung besteht aus der Wundkonditionierung (Wunddebridement, feuchte Wundbehandlung, VAC-Therapie etc.) mit nachfolgender Wundstimulation. Der definitive Wundverschluss kann nach entsprechender Konditionierung entweder plastisch-chirurgisch oder aber durch Stimulation der Granulation und Epithelialisierung mittels unterschiedlichen neuen Therapieverfahren (z. B. Proteaseinhibitoren, Wachstumsfaktoren, Tissue Engineering) erfolgen.

Abstract

Chronic wounds are long-term results of various diseases. Evaluation and therapy of the underlying disorder must be the first goal of a comprehensive wound care protocol. Treatment of local (i.e. wound infection, necrosis, or foreign body) or systemic (i.e. diabetes, immunosuppression, or patient compliance) disturbing factors is the second major step for appropriate wound care. The third major point is wound bed preparation (i.e. debridement, moist wound dressings, or VAC therapy), and wound stimulation. After appropriate wound bed preparation, wounds can be closed by plastic surgery or wound stimulation through various agents (i.e. protease inhibitors, growth factors, or tissue engineering).

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Literatur

  1. Armstrong DG, Nguyen HC, Lavery LA, Carine HM, Boulton AJM, Harkless LB (2001) Off-loading the diabetic foot wound. a randomized clinical trial. Diabetes Care 24:1019–1022

    CAS  PubMed  Google Scholar 

  2. Ashcroft GS, Horan MA, Ferguson MW (1997) The effect of aging on wound healing: Immunlocalisation of growth factors and their receptors in a murine incisional model. J Anat 190:351–365

    Article  PubMed  Google Scholar 

  3. Ashcroft GS, Mills SJ, Ashworth JJ (2002) Aging and wound healing. Biogerontology 3:337–345

    Article  CAS  PubMed  Google Scholar 

  4. Bianchi C, Ballard JL, Abou-Zamzam AM, Teruya TH (2003) Subfascial endoscopic perforator vein surgery combined with saphenous vein ablation: Results and critical analysis. J Vasc Surg 38:67–71

    Article  PubMed  Google Scholar 

  5. Burnand KG, Clemenson G, Morland M, Jarrett PEM, Brows NL (1980) Pericapillary fibrin in the ulcer-bearing skin of the leg: The cause of lipodermatosclerosis in venous ulceration. BMJ 280:7–11

    CAS  PubMed  Google Scholar 

  6. Cullen B, Smith R, McMulloch E, Silcock D, Morrison L (2002) Mechanism of action of Promogran, a protease modulating matrix, for the treatment of diabetic foot ulcers. Wound Rep Reg 10:16–25

    Article  Google Scholar 

  7. Falanga V, Eaglstein WH (1993) The „Trap hypothesis“ of venous ulceration. Lancet 341:1006–1008

    Article  CAS  PubMed  Google Scholar 

  8. Falanga V, Sabolinski M (1999) A bilayered living skin construct (Apligraf) accelerates complete closure of hard-to-heal venous ulcers. Wound Rep Reg 7:201–207

    Article  CAS  Google Scholar 

  9. Fleischmann W, Russ M, Moch D, Marquard C (1999) Biochirurgie—Sind Fliegenmaden wirklich die besseren Chirurgen? Chirurg 70:1340–1346

    CAS  PubMed  Google Scholar 

  10. Ford CN et al. (2002) Interim analysis of a prospective, randomised trial of vacuum assisted closure versus healthpoint system in the management of pressure ulcers. Ann Plast Surg 49:55–61

    Article  PubMed  Google Scholar 

  11. Geissberger M, Fleischmann W (2002) The biobag—a new device for the application of medicinal maggots. Darmatology 204:306–307

    Article  Google Scholar 

  12. Ha Van G, Siney H, Hartmann-Heurtier A, Jacqueminet S, Greau F, Grimaldi A (2003) Nonremovable, windowed, fibroglass cast boot in the treatment of diabetic plantar ulcers: Efficacy, safety, and compliance. Diabetes Care 26:2848–2852

    PubMed  Google Scholar 

  13. Hach W (2001) Das chronisch venöse Kompartmentsyndrom. Zentralbl Chir 126:472–475

    Article  CAS  PubMed  Google Scholar 

  14. Horch RE, Bannasch H, Kopp J, Andree C, Stark GB (1998) Single cell suspension of cultured human keratinocytes in fibrin glue reconstitute the epidermis. Cell Transplant 7:309–317

    Article  CAS  PubMed  Google Scholar 

  15. Iafrati MD, Pare GJ, O’Donnel TF, Estes J (2002) Is the nihilistic approach to surgical reduction of superficial and perforator vein incompetence for venous ulcer justified? J Vasc Surg 36:1167–1174

    Article  PubMed  Google Scholar 

  16. Kalra M et al. (2001) Limb salvage after successful pedal bypass grafting is associated with improved long term survival. J Vasc Surg 33:6–16

    PubMed  Google Scholar 

  17. Marston WA, Hanft J, Norwood P, Pollak R (2003) The efficacy and safety of Dermagraft in improving the healing of chronic diabetic foot ulcers. Diabetes Care 26:1701–1705

    PubMed  Google Scholar 

  18. Moffatt CJ et al. (2003) Randomized trial of four-layer and two-layer bandage system in the management of chronic venous ulceration. Wound Rep Reg 11:166–171

    Article  Google Scholar 

  19. Piaggesi A et al. (1998) Conservative surgical approach versus non-surgical management for diabetic neuropathic ulcers: a randomized trial. Diabet Med 15:412–417

    Article  CAS  PubMed  Google Scholar 

  20. Pomposelli FB et al. (1995) Dorsalis pedis arterial bypass: Durable limb salvage for foot ischemia in patients with diabetes mellitus. J Vasc Surg 21:375–384

    PubMed  Google Scholar 

  21. Prete PE (1997) Growth effects of phaenicia serata larval extracts on fibroblasts: Mechanism for wound healing by maggot therapy. Life Science 60:505–510

    Article  CAS  PubMed  Google Scholar 

  22. Rojas AI, Phillips TJ (1999) Patients with chronic leg ulcers show diminished levels of vitamins A and E, carotenes, and zinc. Dermatol Surg 25:601–604

    Article  CAS  PubMed  Google Scholar 

  23. Scherer LA, Shiver S, Chang M, Meridith W, Owings JT (2003) The vacuum assisted closure device. A method of securing skin grafts and improving graft survival. Arch Surg 137:930–934

    Article  Google Scholar 

  24. Smith J (2002) Debridement of diabetic foot ulcers. Cochrane-Database-Syst-Rev 4

  25. Steed DL, Donohoe D, Webster MW, Lindsley L (1996) Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. J Am Coll Surg 183:61–64

    CAS  PubMed  Google Scholar 

  26. Thomas DR (2001) Improving outcome of pressure ulcers with nutritional interventions: A review of the evidence. Nutrition 17:121–125

    Article  CAS  PubMed  Google Scholar 

  27. Tsang MW et al. (2003) Human Epidermal Growth Factor enhances healing of diabetic foot ulcers. Diabetes Care 26:1856–1861

    CAS  PubMed  Google Scholar 

  28. Veves A, Falanga V, Armstrong DG, Sabolinski M (2001) Graftsskin, a human skin equivalent, is effective in the management of non infected neuropathic diabetic foot ulcers. Diabetes Care 24:290–295

    CAS  PubMed  Google Scholar 

  29. Veves A, Sheehan P, Pham HT (2002) A randomised, controlled trial of Promogran (a collagen/oxidised regenerated cellulose dressing) vs standard treatment in the management of diabetic foot ulcers. Arch Surg 137:822–827

    Article  CAS  PubMed  Google Scholar 

  30. Vin F, Teot L, Meaume S (2002) The healing properties of Promogran in venous leg ulcers. J Wound Care 11

  31. Wiemann TJ, Smiell JM, Su SY (1998) Efficacy and safety of a topical gel formulation of recombinant human Platelet-Derived Growth Factor-BB (Becaplermin) in patients with chronic neuropathic diabetic ulcers. Diabetes Care 21:822–827

    Google Scholar 

  32. Winter GD (1962) Formation of scab and the rate of epithelialisation of superficial wounds in the skin of the young domestic pig. Nature 4812:293–294

    Google Scholar 

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Authors and Affiliations

  1. Klinik für Allgemeine Chirurgie, Chirurgische Universitätsklinik Tübingen

    S. Coerper

  2. Klinik für Allgemeine Chirurgie, Chirurgische Universitätsklinik Tübingen, Hoppe-Seyler-Straße 3, 72076 , Tübingen

    S. Coerper

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  1. S. Coerper
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  2. S. Beckert
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  3. H. D. Becker
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Correspondence to S. Coerper.

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Coerper, S., Beckert, S. & Becker, H.D. Korrekturmöglichkeiten der gestörten Wundheilung. Chirurg 75, 471–476 (2004). https://doi.org/10.1007/s00104-004-0843-7

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