Evidenz in der lokalen Therapie chronischer Wunden: Was ist gesichert?

 

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Zusammenfassung

Chronische Wunden sind ein komplexes Symptom verschiedener Grunderkrankungen. Sie können bspw. vaskulärer, metabolischer oder immunologischer Genese sein. Auch wenn die Therapie dieser Grunderkrankungen im Vordergrund steht und zielführend ist, so beeinflussen diese Wunden die Lebensqualität der einzelnen Patienten oder Patientinnen stark. Zur Lokaltherapie chronischer Wunden steht ein breites Portfolio an Möglichkeiten zur Verfügung. Anders als in anderen Bereichen der Medizin ist die Evidenz für die verschiedenen Lokaltherapeutika meist gering. Deshalb rücken Experten-Empfehlungen und Leitlinien an ihre Stelle, die sinnvolle Behandlungspfade aufzeigen. Die wichtigsten Fragestellungen in der täglichen Praxis betreffen die Wahl und Effektivität der Wundspülung und des Wunddebridements, das Exsudatmanagement, den Einsatz von antimikrobiellen Wirkstoffen in Lösungen und Wundauflagen, die Unterdruck-Wundtherapie (NPWT) und die Indikationsstellung zur Kompressionstherapie. Trotz des Mangels an Evidenz folgt die Behandlung chronischer Wunde einigen grundlegenden Prinzipien, die im folgenden Artikel inklusive der dazugehörigen Behandlungsempfehlungen dargestellt werden.

Abstract

Chronic wounds are a comprehensive symptom of various underlying diseases. For example, they can be vascular, metabolic or immunological in nature. Even if the therapy of these underlying diseases is in the focus, these wounds have a great impact on the quality of life of the individual patient. A broad portfolio of choices is available for the local therapy of chronic wounds. In contrast to other fields of medicine, the evidence for the various local therapeutic options is mostly limited. Therefore, expert recommendations, guidelines, and directives are replacing them to provide reasonable treatment pathways. The most important issues in daily practice relate to the choice and efficacy of wound irrigation and debridement, exudate management, the use of antimicrobial agents in solutions and wound dressings, negative pressure wound therapy (NPWT), and the indications for compression therapy. Despite the lack of evidence, the management of chronic wounds adheres to some fundamental principles, which are outlined in the following article, including the related treatment recommendations.

Publication History

Article published online:
13 July 2021

© 2021. Thieme. All rights reserved.

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