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Zentralbl Chir 2017; 142(03): 306-311
DOI: 10.1055/s-0042-109977
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Rezidivprophylaxe des Ulcus cruris venosum

Prophylaxis of Recurrent Venous Leg Ulcer
K. Kroeger
1   Angiologie, HELIOS Kliniken Krefeld, Deutschland
,
M. Storck
2   Gefäßzentrum Karlsruhe, Städt. Klinikum Karlsruhe, Deutschland
,
P. Kujath
3   Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
,
E. Rabe
4   Klinik für Dermatologie, Universitätsklinik Bonn, Deutschland
,
J. Dissemond
5   Klinik für Dermatologie, Universitätsklinik Essen, Deutschland
› Author Affiliations
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Publication History

Publication Date:
08 August 2016 (online)

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Zusammenfassung

Das Ulcus cruris venosum (UCV) ist in Europa eine der häufigsten chronischen Wunden. Die Therapie ist langwierig, mühsam und kostenintensiv, und es besteht eine hohe Rezidivquote. In diesem Beitrag werden die Maßnahmen dargestellt, die jedem Patienten mit abgeheiltem UCV angeboten werden sollten, um das Auftreten eines erneuten UCV dauerhaft zu verhindern. Um einem UCV bei Varikose vorzubeugen, muss die Progression der chronischen venösen Insuffizienz (CVI) gestoppt werden. Es existiert eine überzeugende Evidenz dazu, dass die effiziente Therapie der Varikose bei Patienten mit UCV die Rezidivrate senkt. Bei Patienten mit einem postthrombotischen Syndrom (PTS) sollten weitere Thrombosen durch eine gezielte Thromboseprophylaxe verhindert werden. Für den Nutzen endovaskulärer rekanalisierender Verfahren bei Patienten mit postthrombotischen Veränderungen der Beckenvenen auf die Rezidivrate des UCV gibt es bisher keine Studien. Für UCV bei Varikose und PTS wurde in mehreren Studien eindrücklich gezeigt, dass die Kompressionstherapie die Basismaßnahme für die Prävention eines Ulkusrezidivs ist, unabhängig davon, ob andere Maßnahmen durchgeführt wurden oder nicht. Wichtiger als eine möglichst hohe Kompressionsklasse ist eine gute Adhärenz der betroffenen Patienten bei der Kompressionstherapie. Das Ziel zukünftiger Bemühungen für Patienten mit UCV muss es sein, den Therapeuten Instrumente und Behandlungsstrategien an die Hand zu geben, den Patienten zu führen und dessen Akzeptanz und Verständnis für die Bedeutung des Selbstmanagements insbesondere der Kompressionstherapie für die Rezidivprophylaxe zu erhöhen.

Abstract

Venous leg ulcer (VLU) counts among the most common chronic wounds in Europe. Treatment is lengthy, cumbersome and costly, and there is a high rate of recurrence. This review shows the measures that should be offered to every patient with healed VLU to permanently prevent recurrence. To prevent VLU in case of varicose veins, the progression of chronic venous insufficiency (CVI) has to be stopped. There is convincing evidence that the effective treatment of varicose veins reduces the recurrence rate in patients with VLU. In patients with post-thrombotic syndrome (PTS), further thrombosis should be prevented through targeted prophylaxis of new thromboembolic events. The benefit of endovascular revascularization on the VLU recurrence rate in patients with post-thrombotic damage in the pelvic veins has not been proven in clinical studies. On the other hand, it has been clearly demonstrated in several studies that compression therapy is the basic procedure for the prevention of recurrent VLU in patients with varicose veins or PTS, regardless of whether other measures have been implemented or not. Good adherence in patients with compression therapy is more important than choosing the highest possible compression class. Future efforts for patients with VLU must aim to provide therapists with tools and treatment strategies to guide their patients and to increase patientsʼ acceptance and understanding of the importance of self-management, in particular regarding compression therapy for the prevention of recurrent VLU.

Schlüsselwörter

chronische Wunde - Varikose - Wundheilung

Key words

chronic wound - varicosis - wound healing
 

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