Recherche de publication

Diabetische Fußulzera gehören weltweit zu den häufigsten Ursachen

für Amputationen im Bereich der unteren Extremitäten. Alleine in

Deutschland sind nach Schätzungen der AOK für das Jahr 2001 ca.

29.000 Diabetiker betroffen, das entspricht fast 70% aller nicht-traumatischen Amputationen1 .

Säulen der Therapie dieser diabetesbedingten Läsionen sind ein

fachgerecht ausgeführtes Wunddebridement und die Entfernung

avitalen Gewebes, eine adäquate lokale Wundversorgung und eine

effektive Druckentlastung. Insbesondere der Druckentlastung kommt

in diesem Behandlungsschema eine ganz entscheidende Rolle zu.

Nur so können die Druckspitzen in den betroffenen Fußregionen wir-

kungsvoll minimiert und wundfördernde Scherkräfte vermieden wer-

den. Während bisher in Deutschland zur Druckentlastung vorrangig

therapeutisches Schuhwerk (z.B. Vorfußentlastungsschuhe) einge-

setzt werden, wird in anderen Ländern, beispielsweise in den USA,

die Druckentlastung mittels vollflächigem Gips- oder Castverband (Total Contact Cast) bereits über 20 Jahre praktiziert2, 3 . Die in der Li-

teratur beschriebenen Heilungsraten dieser Behandlungsmethode

sind überzeugend, dennoch ist dieses Prinzip in Deutschland bisher

noch wenig verbreitet.

Zur Testung der Effektivität einer Druckentlastung durch individuell angepasste, gepolsterte Cast-Schuhe, ähnlich dem Prinzip des „Total Contact Cast“, wurde diese Pilotstudie initiiert. Die Durchführung erfolgte in der Chirurgischen Ambulanz des DRK-Krankenhauses in Hachenburg in Zusammenarbeit mit einer diabetologisch qualifizierten Allgemeinarztpraxis. Zusätzlich zur Druckentlastung wurde die Wundheilung mit Produkten der Modernen Wundversorgung unterstützt.

Exudates from non-healing wounds contain elevated levels of proteolytic enzymes, like elastase from polymorphonuclear granulocytes (PMN elastase), reactive oxygen species (ROS) and reactive nitrogen species (RNS). The overproduction of proteolytic enzymes leads to reduced concentrations of growth factors and proteinase inhibitors, resulting in an imbalance between degradation and remodelling processes. Thus, the reduction of protein-degrading enzymes and scavenging of ROS and RNS seem to be suitable ways to support the healing process of chronic stagnating wounds. The aim of this study was to test selected wound dressings from different biomaterials (collagen, oxidized regenerated cellulose (ORC) and ORC/collagen mixture), regarding their antioxidative potential in vitro and their influence on the concentration and activity of PMN elastase in chronic wound fluid. Antioxidant capacity of the investigated wound dressing was determined by a pholasin-based chemiluminescent assay. PMN elastase concentration was determined by means of ELISA. Enzyme activities could be measured by a fluorescence assay. As the presented data demonstrates, all tested materials showed antioxidant capacity. In addition, the investigated materials were able to reduce the concentration and activity of PMN elastase. Beside other aspects, such as biocompatibility, biodegradability, fluid absorption and clinical effects (e.g. angiogenesis and microcirculation), the understanding of these properties may help to support the further refinement of wound dressings for improved wound healing.

Introduction:

Regarding the years of successful use Suprasorb® C of Lohmann & Rauscher (a special wound dressing composed of collagen type I), we performed a case study on nine patients with very large and mainly surgical wounds of a severe nature. The purpose was to demonstrate the effective and practical use of collagen dressings in these cases.

Methods

Descriptive investigation by determined criteria, put in a special form, was used to document the treatment as detailed as possible.

Results:

The average age of the patients was 60 years. Four of them had a postoperative wound disturbance in the abdominal area. A surgical removing of debris had been executed on 3 patients. Maggots were used on one patient to clean the wound area. In a single case honey and silver dressings were used to cure infections. Because of an extremely large wound in four cases, vacuum sealing was used to initiate wound closure. We used modern wound care products of the Suprasorb® line around the tenth day of treatment. In seven cases we applied firstly the alginate in order to clean the wound furthermore. We resumed treatment with collagen (Suprasorb® C) in all nine cases to accelerate the healing process of the wound. Foil and foam wound dressings were used additionally as secondary wound dressings to cover up the wound. Additional therapy was not necessary. The average wound surface at the beginning of the treatment was 101,5 cm2. At the end, it had been decreased to an average of 2,8 cm2 in 76 days, which meant a reduction of 97,2%.

Conclusions

Suprasorb® C is a patient-friendly and effective wound care product to heal secondary healing wounds eg severe surgical wounds. Further investigation concerning the duration of the wound healing process in comparison to conventional wound treatment is advisory.