Pfeffer F, von Dobschuetz E, Riediger H, Moosmann C, Hopt U T
Abteilung für Allgemein- und Viszeralchirurgie, Chirurgische Universitätsklinik Freiburg i. Br.
MMW Fortschr Med. 2004 Oct 28;146(44):45-8.
The most common chronic wounds are pressure ulcers, diabetic ulcers, arterial occlusive disease and venous ulcers. The therapeutic aim after appropriate diagnostic work-up is causal treatment. Pressure relief, revascularisation or compression head the list of potential measures. Apart from local factors such as infection or necrosis, systemic factors such as patient compliance, renal insufficiency and immunosuppression are of relevance. If there is a chance of healing, wound management comprises repeated debridement and wet dressings. In the presence of an infection, local antiseptic treatment is indicated. In the individual case, wound stimulation can be supported by protease inhibitors, growth factors or tissue engineering. Definitive wound closure is achieved by epithelial migration from the margins of the wound, or by plastic surgery. Regular documentation of the course and success of wound healing is mandatory. In the wound care center, surgical disciplines, diabetology, dermatology and diagnostic work-up are coordinated, and liaison with the family doctor and home care providers practiced. This wound healing concept successfully heals approximately 80% of the cases of chronic wounds in 18.8 months (mean healing duration 4.8 months).
最常见的慢性伤口是压疮、糖尿病溃疡、动脉闭塞性疾病和静脉溃疡。经过适当的诊断检查后，治疗目标是进行病因治疗。减压、血管再通或加压是潜在治疗措施的首要内容。除了感染或坏死等局部因素外，患者依从性、肾功能不全和免疫抑制等全身因素也很重要。如果有愈合的可能，伤口处理包括反复清创和湿敷料。存在感染时，需进行局部抗菌治疗。在个别情况下，可使用蛋白酶抑制剂、生长因子或组织工程技术辅助伤口刺激。通过伤口边缘的上皮迁移或整形手术实现伤口的最终闭合。必须定期记录伤口愈合的过程和效果。在伤口护理中心，外科学科、糖尿病学、皮肤病学以及诊断检查相互协调，并与家庭医生和家庭护理人员保持联系。这种伤口愈合理念在18.8个月内成功治愈了约80%的慢性伤口病例（平均愈合时间为4.8个月）。
