Treatment of chronic ulcers

Summary

Chronic ulcers (CUs) are a major cause of morbidity and mortality with increasing prevalence, in part due to the ageing population, and an increase of risk factors such as diabetes and obesity. CUs are caused by numerous diseases including venous dysfunction, diabetes mellitus, infections, peripheral neuropathy, pressure, and atherosclerosis. The current standard therapy for CUs includes compression, surgical débridement, infection control, and adequate wound dressings. As a high percentage of CUs do not adequately heal or quickly relapse with standard treatments, additional therapeutic approaches are pursued, termed “advanced wound care therapies”. Here, an overview on commonly applied therapies lacking significant evidence for wound healing is reviewed, followed by therapies with significant evidence supporting the routine use in the treatment of CUs, and a short outlook in a possible future wound treatment landscape.

To give a résumé, the presented literature reveals that most of the commonly applied topical and advanced ulcer treatments largely lack solid scientific evidence for the induction or acceleration of wound healing. Surprisingly only “classical” treatments such as wound cleansing, débridement and compression have significant evidence. Novel approaches such as bilayered skin reconstructs, cell suspensions or extracorporal shock waves seem promising. Considering the increasing number of ulcer patients, there is a strong need for further basic research to fully understand all factors involved in wound development and healing of the various ulcer pathophysiologies, and the urgent need for prospective clinical trials comparing the various treatment options.

Zusammenfassung

Das chronische Ulkus ist eine schwerwiegende Erkrankung mit steigender Inzidenz, was vor allem auf die alternde Gesellschaft und die Zunahme von Risikofaktoren wie Diabetes mellitus und Adipositas zurückzuführen ist. Chronische Ulzera haben vielerlei zugrundeliegende Pathologien wie beispielsweise venöse Dysfunktion, Diabetes mellitus, Infektionen, Neuropathie, Druck und Atherosklerose. Die gegenwärtige Standardbehandlung des chronischen Ulkus beinhaltet Kompression, Débridement, Infektionsprophylaxe sowie der Heilungsphase angepasste Wundauflagen. Da ein grosser Anteil chronischer Wunden unter der Standardbehandlung nicht vollständig abheilt oder rasch rezidiviert, werden häufig moderne Zusatzbehandlungen notwendig. Im vorliegenden Übersichtsartikel wurde mittels Literaturrecherche die aktuelle Datenlage bezüglich Wundbehandlungen untersucht. Insbesondere wurde gezielt danach gefragt, in wie fern sich die jeweiligen Behandlungsmethoden auf wissenschaftliche Evidenz stützen, bzw. für welche Behandlungsmethoden es keine belastbaren wissenschaftlichen Daten gibt. Darüber hinaus wurden neuartige Wundbehandlungen untersucht, welche in Zukunft eine wichtige Rolle in der Wundbehandlung spielen könnten.

Zusammenfassend lässt sich feststellen, dass die meisten der derzeitigen klassischen und modernen Wundbehandlungen auf nur wenig belastbaren wissenschaftlichen Daten beruhen und der Evidenzgrad in Bezug auf Induktion bzw. Beschleunigung der Wundhei-lung sehr niedrig ist. Erstaunlicherweise lassen sich aus den vorliegenden Studiendaten bisher nur klassische Behandlungen wie Wundreinigung, Débridement und Kompression als gesicherte Therapien mit solider Evidenzlage ableiten. Neue Therapieansätze wie zelluläre zweischichtige Hautrekonstrukte, Zellsuspensionen oder extrakorporale Stoß-wellen scheinen wirksam zu sein. In Anbetracht der steigenden Inzidenz des chronischen Ulkus ist weitere Grundlagenforschung dringend notwendig, um die Mechanismen der Wundentstehung und -heilung der verschiedenen zugrundeliegenden Pathophysiologien im Detail zu verstehen. Darüber hinaus besteht eine große Notwendigkeit für klinische Studien, in denen die verschiedenen Behandlungsoptionen prospektiv miteinander verglichen werden.

Keywords

Ulcer - wound healing - wound dressing - therapy

Schlüsselwörter

Ulkus - Wundbehandlung - Wundauflage - Therapie

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