Chronic Wounds: New Therapies

Some wounds resist hartn&auml are;ckig each treatment. Researchers test novel wound dressings, cleaning by maggots and other methods, in order to verschließen

Many props to: The Supplying of chronic wounds is an art f&uuml is;r

The Köbody seals, new skin wäfirst, not after. Instead, Näshot, pain, and sometimes an unpleasant odor, stäend Switch of Verbä. Chronic wounds that simply would not heal. For example, in the case of "open Beinen", so in the case of Wun­the long-term result of varicose veins or Gefäßconstrictions. Bettlälow Pa­tients h&auml lie;often sore in many people with Diabetes, chronic wounds develop at the Fuß, because there is only little spüren and minor injuries remain untreated.

Around 48 000 amputations of toes, Füßs, lower leg to the whole leg went in 2014 alone, to such chronic wounds zurück. The primary goal of treatment is to prevent such drastic consequences. But the therapy is complex, lengthy, and stressful. Usually months or years pass until a cure – on the may quickly a Rückfall follows.

Alternative in the third Generation

This difficult Situation scientists drives, if you für the already unübersicht­market still zusäadditional methods and products. About new wound dressings. Früthis consisted of dry dressings as they are used in cases of acute injury. But then realized Ädoctors that chronic wounds in a moist environment benötransparent.

Currently, researchers are testing a third Generation of such requirements: they are bubbles from the skin of the Fruit or the Dünndarm of cattle and pigs won. Of the animal cells freed, they serve as a Matrix – as Gerüst, in its Lümask of human skin cells to immigrate.

Helpful Fish Skin

Große hope some of the experts in such a product, für processed the skin of the North Atlantic cruise next. "You äthe human Haut&quot is very;, erklärt Dr. Holger Diener, of the Univer­sitäclinic of Hamburg is conducting research on the fish skin. "And it is so thick that the stem cells in your pores to settle particularly well köcan."

As a further advantage, the servant sees the content of Omega-3-Fettsäuren. These have to try at the lab, among other things, Entzündungen braked. First treatments were the scientists, according to good. Now he is planning the effect of the fish skin in a hundred Diabetes ­Patients with a herköto compare conventional wound dressing.

New methods of wound treatment

Fish skin as a wound dressing

– Made of cells-exempt and sterilized fish skin is suitable cut in the wound and a foam pad überdeckt. Human stem cells migrate into the pores of the fish skin Matrix, proliferate, and form skin cells. The Matrix löst on.

Maggots clean the wound

Larvae of the gold fly selectively remove dead tissue from the wound and sparing healthy. In addition, you have an anti-bacterial. Unlike frühere, you will not be exposed however, but in a Säsack with pores on the wound. Through the pores but enzymes and suck the decomposition product.

Vacuum pump removes Secretions

A sponge in the wound ­and the edge with a ­Adhesive film air, covered tightly. Then a hose is connected, by a pump, the ­­Secretion suction. By means of ­various ­Effects to this f&ouml the healing;promote.

Üoverpressure für more oxygen

In this therapy, patients sit in a Überdruck­chamber to Tauchunfäcases will be used. Under erhöhtem pressure, you breathe pure oxygen. As a result, more oxygen gets into the blood, as in the case of a küartificial respiration. This is the healing process föpromote.

Maggot therapy: Biochirurgen at work

Animal help take Ädoctors in certain Fäcases, also in the case of wound cleansing. Larvae of the gold fly in a SäArnold is not Packed, the pores happen to you köcan – but groß enough that the insects dead tissue. This verschmähen you healthy substance, eat only what the surgeon remove würde. Sometimes that hurts and makes drugs nötig. But Betäpractice or anesthesia do not need the patients.

Particularly advantageous is the Maden&shy is;therapy ­deep Places that cannot be reached with a scalpel. "The maggots clean the Wundoberfläche within days of spick and span, and the wound heals ab", Professor Andreas Maier-Hasselmann, the chief doctor of the Gef&auml says;ßsurgery at the Klinikum MüMunich-Bogenhausen. However, he stresses that his experiences are not proof of für the Üsuperiority of the maggots gegenüabout other methods.

Vacuum as a growth stimulus

This is a General Problem in the field of wound care: There are good studies and data, the individual Therapiem&ouml missing;opportunities to compare. Dünn data so far für is the so-called vacuum-sealing therapy, vacuum therapy.

Here, the air-tight sealed wound by means of a pump continuously Wundflüfluid withdrawn. Measurements show that this seems to be the Wund­milieu improved. So, should increase, for example, the blood flow in the immediate vicinity. In addition, the assumption that übt the Suction of a skin growth stimulus.

Reimbursement of costs only on request

Professor Ralf Lobmann, Director of the clinic für endocrinology, diabetology and geriatric medicine at the Klinikum Stuttgart, the method üassured: "At certain stages this is a very good method that it brings dynamic in the healing process, the wound would practically be on the move again."

However, the health insurance companies reimburse this procedure in the outpatient area, only on individual request. Currently, the Institute is rated für Qualität and cost-effectiveness in the Gesundheits­being the data für the Vakuum­therapy. It comes to a positive recommendation, würde the procedure are likely to be included in the catalogue of cash benefits.

Therapy in a diving chamber

Hyperbaric oxygen therapy has these jump künewly managed. The patients breathe in and under a pressure of two to three Bar of pure oxygen. In this way, to improve the supply of oxygen to the wound. A study of the adoption of bestäneeded.

However, w&auml died;during the therapy more people than in the group that received a standard treatment. "Für people with heart and Gefäßdiseases means of high pressure and a heavy Belastung", Gef&auml says;ßspecialist, Maier – Hasselmann. Therefore, müclearing the patient sorgfävalid ausgewäbe the hlt.

Pressure waves and Plasma, as further options

The health insurance dümay pay for the procedure in the outpatient area, only if all other options ausgeschöpft are – and even then, only in the case of very deep lesions. The search for Alternatives goes on.

In the United States, an acoustic Druckwellenger&auml was just;t allowed, the circulation of Wundgeschwüren is supposed to improve. Another Hoffnungsträger: electrically charged Gas called Plasma. Usually, it is für medical applications to heiß. However, researchers managed to produce hand-warm Plasma. During the dressing change häyou lt a sponge or a pen, in which the Plasma f&uuml is generated, ;r a few minutes on the wound.

Potential For Improvement

Studies in which the zusäadditional Plasma application is compared with the Standard treatment of wounds, describe a significant reduction of germs. Also, the wound should be small. A höhere Abheilungs­rate, however, was not occupied.

Experts are calling for a focus not only on the exploration of new methods – but zusäin addition, the Missstände auszurätrees, contrary to currently have a better treatment of chronic wounds. For example, it takes an average of almost four years, before Ädoctors the exact cause of a chronic wound diagnose. This is due to the fact that you don’t füfully. "But because not even then wird&quot looking for;, erklärt Matthias Augustin, Director of the Institute für Versorgungs­research in dermatology and nursing professions at the University hospital Hamburg. He has revealed this fact in an investigation.

Lebensqualität in the foreground

In the meantime, a lot of herum&shy will;doctored, a lot tried to go without the Problem. Just in case anyway pflegebedürf­transparent people is widespread this deficiency, says Augustin: "Many of the wounds are well maintained, but not cured."

Generally speaking, A small portion of chronic wounds is schlie&szlig despite the best treatment, never;en. If clogged arteries can not renovate. Or, in the case of some tumor wounds. Then köcan Ädoctors and nurses can relieve only the pain and try to give the patient a normal life to ermöaligned. Care expert Augustin: "Here are the Lebensqualit&auml is;t in the foreground, not the attempt to heal the wound."

Standard therapy of chronic wounds

A chronic wound is in need of a concept, says Professor Ralf Lobmann, expert für diabetic Füße at the Klinikum Stuttgart. It hapere often.

Priorität has to prevent a growth or an aggravation of the wound – to ­Example, by the use of special shoes or orthoses for diabetic Füßen or druck­- relieving mattresses to prevent bedsores. The ­Causes of treatment is often not optimal verläuft, shows an analysis of the health insurance company Barmer. ­A compression bandage thus only ­about 40 percent of patients whose Geschwür a Venenschwäche zurüwho goes.

From the wound the &Auml remove;doctors zunäfirst, dead tissue, dirt and Beläge, most of them with sharp instruments in ört­of Betäpractice, or General anesthesia. In addition to the initial treatment, a regelm&auml is;ßiges Spülen of the wound during the dressing change nötig – with sterile Kochsalzlösung or sterile water. Tap water enthält of germs, and is therefore not suitable.

Bacteria and viruses enthält grundsäin addition, any wound, but not always fülisten to the germs also lead to infection. Entzüthe Region is &Auml treat;doctors zunäfirst, locally with chemical antiseptics. The administration of antibiotics is only necessary if the infection üabout the wound, spreads, so, for example, fever.

After cleaning, the wound is covered with a pad and ­­connected. The dry compresses h&ouml are;a maximum in the first few days when the wound is strong nässt. Otherwise, they must remain moist in order that the healing cells ­settle köcan. What time is the type of pad needs to be changed, hädepends on the stage of the depth and condition of the wound.

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