[International clinical recommendations on scar management]. / Internationale Klinische Empfehlungen zur Narbenbehandlung.

Many techniques for management of hypertrophic scars and keloids have been proven through extensive use, but few have been supported by prospective studies with adequate control groups. Several new therapies showed good results in small-scale trials, but these have not been repeated in larger trials with long-term follow-up. This article reports a qualitative overview of the available clinical literature by an international panel of experts using standard methods of appraisal. The article provides evidence- based recommendations on prevention and treatment of abnormal scarring and, where studies are insufficient, consensus on best practice. The recommendations focus on the management of hypertrophic scars and keloids, and are internationally applicable in a range of clinical situations. These recommendations support a move to a more evidence-based approach in scar management. This approach highlights a primary role for silicon gel sheeting and intralesional corticosteroids in the management of a wide variety of abnormal scars. The authors concluded that these are the only treatments for which sufficient evidence exists to make evidence-based recommendations. A number of other therapies that are in common use have achieved acceptance by the authors as standard practice. However, it is highly desirable that many standard practice and new emerging therapies undergo large-scale studies with long-term follow-up before being recommended conclusively as alternative therapies for scar management.

[Treatment of chronic wounds with an alginate dressing containing calcium zinc and manganese]. / Behandlung chronischer Wunden mit einer Kalzium-Zink-Mangan-Alginatauflage.

BACKGROUND: Treatment of chronic wounds comprises adequate debridement, reduction in the bacterial burden, and application of a dressing to absorb excess exudate. METHODS: In a prospectively documented, multicenter observational study involving 1285 chronic wounds of varying etiologies, carried out in 314 doctor's offices in Germany, the effect of the new alginate dressing, containing calcium zinc and manganese was investigated. RESULTS: After twelve weeks of treatment with the dressing, 95% of all wounds had improved appreciably, and 52.5% had healed completely. The drop out rate was 4.4% and side effects were observed in 2.6% of the cases. 73.8% of the patients reported markedly improved tolerability in comparison with previous treatment. 604 patients (47.0%) considered handling of the dressing to be "much better", and 411 (32.0%) to be "better" than previous treatment. The frequency of dressing changes decreased from 5.2 to 3.2 a week.

[Skin substitutes in chronic wounds]. / Hautersatzverfahren bei chronischen Wunden.

Skin substitutes in chronic wounds. There is a large demand for skin substitutes for the coverage of chronic wounds. Due to a intensive and local wound treatment the impaired dermal and epidermal repair still remains a major problem. Known treatmentes as split-skin-, reverdin- and pinch grafts make a sufficient and solid wound closure possible. However in such procedures the take rate of grafting often failes. The graft healing is increased with combined mesh-graft and vacuum-sealing technique. Temporary and permanent skin substitutes extend the spectrum in closure of chronic defects. Sheets and single cell suspensions of keratinocytes are available for clincial treatments. First clinical results with autologous keratinocyte transplantation are described. In the future approaches in gen therapy becomes more and more important for skin substitutes.

[The role of growth factors in wound healing]. / Die Rolle der Wachstumsfaktoren in der Wundheilung.

Growth factors are mediators with essential importance for undisturbed repair process after wounding. The well coordinated concert of these substances is necessary for healing with complete restoration of function and morphology. These complex mechanisms are disturbed during secondary and delayed repair. The result is protracted healing course and inferior scar quality--either hypo- or hypertrophic. Local and systemic application of these growth factors seems to add important instruments for therapeutic use in the treatment of chronic wounds. Knowledge from experimental research is encouraging, although the exact mechanisms of synergistic action are not completely understood. However, the results from clinical use in controlled studies do not meet these expectations by far. The main reasons for this dilemma are thought to be little understanding in the complex interactions of these substances. In fact, different wound entities seem to reveal different cytokine profiles during the course of repair. Further intensive research therefore is required for the rational use of growth factors in the clinical setting.

[Ambulant treatment of wounds by vacuum sealing]. / Ambulante Wundbehandlung durch Vakuumversiegelung.

The treatment of chronic wounds by vacuum sealing as an outpatient procedure is a new method of wound conditioning before closing the defect. The quality of life for the patient in his usual surrounding is maintained. Financial aspects also play a role in this treatment since costs for the health care system can be reduced. Various vacuum pumps, drainages and polymere foams are available and suitable for the outpatient treatment. The most important condition is to regularly check the vacuum. This can performed by the patient, the relatives or nursing staff. The main complication consists in loss of vacuum but technical and local or systemic complications can also appear. Individually applied vacuum dressings (polyvinyl foam, drainage tube and polymere foil) are practical. The ideal pump systems for the outpatient treatment are still not trial.