Der Chirurg

, Volume 78, Issue 4, pp 335–342 | Cite as

Innovative Wundtherapie und Hautersatz bei Verbrennungen

  • P.M. Vogt
  • P. Kolokythas
  • A. Niederbichler
  • K. Knobloch
  • K. Reimers
  • C.Y. Choi


Die Erfolgsbilanz der modernen Verbrennungstherapie in Spezialzentren beruht neben einer spezialisierten Intensivtherapie vor allem auf einer frühen Hautexzision mit autologem Hautersatz. Die Möglichkeiten der konservativen Wundtherapie haben sich vor allem durch den Einsatz innovativer Externa und des Hautersatzes durch bioartifizielle Hautanaloga beträchtlich erweitert. In diesem Beitrag sollen daher aktuelle und innovative Verfahren der konservativen Wundtherapie sowie des Hautersatzes bei Verbrennungen dargestellt werden.


Verbrennungen Verbrennungswunde Heilungsförderung Wundtherapie Hautersatz 

Innovative wound therapy and skin substitutes for burns


The success of modern burn therapy is based mainly on special burn intensive care, topical treatment, early eschar excision, and wound closure by immediate skin grafting or skin substitutes. This paper describes the current state of wound care and skin substitutes in burn therapy.


Severe burns Survival Local antiseptic therapy Wound care Increased healing Skin substitutes 


  1. 1.
    Burke JF, Yannas IV, Quinby WC Jr (1981) Successful use of a physiologically acceptable artificial skin in the treatmentof extensive burn injury. Ann Surg 194: 413CrossRefPubMedGoogle Scholar
  2. 2.
    Callcut RA, Schurr MJ, Sloan M, Faucher LD (2006) Clinical experience with Alloderm: a one-staged composite dermal/epidermal replacement utilizing processed cadaver dermis and thin autografts. Burns 32: 583CrossRefPubMedGoogle Scholar
  3. 3.
    Dimick AR (1971) Management of patients with thermal injuries. Am Surg 37: 637PubMedGoogle Scholar
  4. 4.
    Druecke D, Steinstraesser L, Homann HH et al. (2002) Current indications for glycerol-preserved allografts in the treatment of burn injuries. Burns [Suppl 1] 28: 26Google Scholar
  5. 5.
    Ehrenreich M, Ruszczak Z (2006) Tissue-engineered temporary wound coverings. Important options for the clinician. Acta Dermatovenerol Alp Panonica Adriat 15: 5PubMedGoogle Scholar
  6. 6.
    Ehrenreich M, Ruszczak Z (2006) Update on tissue-engineered biological dressings. Tissue Eng 12: 2407CrossRefPubMedGoogle Scholar
  7. 7.
    Gallico GG 3rd, O’Connor NE, Compton CC et al. (1984) Permanent coverage of large burn wounds with autologous cultured human epithelium. N Engl J Med 311: 448PubMedGoogle Scholar
  8. 8.
    Gant TD (1980) The early enzymatic Débridement and grafting of deep dermal burns to the hand. Plast Reconstr Surg 66: 185CrossRefPubMedGoogle Scholar
  9. 9.
    Hansbrough JF, Achauer B, Dawson J et al. (1995) Wound healing in partial-thickness burn wounds treated with collagenase ointment versus silver sulfadiazine cream. J Burn Care Rehabil 16: 241CrossRefPubMedGoogle Scholar
  10. 10.
    Hansbrough JF, Dore C, Hansbrough WB (1992) Clinical trials of a living dermal tissue replacement placed beneath meshed, split-thickness skin grafts on excised burn wounds. J Burn Care Rehabil 13: 519CrossRefPubMedGoogle Scholar
  11. 11.
    Hansbrough JF, Franco ES (1998) Skin replacements. Clin Plast Surg 25: 407PubMedGoogle Scholar
  12. 12.
    Haslik W, Kamolz LP, Nathschlager G et al. (2007) First experiences with the collagen-elastin matrix Matriderm(R) as a dermal substitute in severe burn injuries of the hand, BurnsGoogle Scholar
  13. 13.
    Hauser J, Rossbach O, Vogt PM et al. (2006) Efficacy of treatment with Repithel and Jelonet in comparison to treatment with Jelonet alone – a randomized clinical trial in patients receiving meshed skin grafts. Zentralbl Chir 131: 315PubMedGoogle Scholar
  14. 14.
    Haynes BWJ (1969) Early excision and grafting in third degree burns. Ann Surg 169: 736PubMedGoogle Scholar
  15. 15.
    Heimbach DM, Warden GD, Luterman A et al. (2003) Multicenter postapproval clinical trial of Integra dermal regeneration template for burn treatment. J Burn Care Rehabil 24: 42CrossRefPubMedGoogle Scholar
  16. 16.
    Hendren WH, Constable JD, Zawacki BE (1968) Early partial excision of major burns in children. J Pediatr Surg 3: 445CrossRefPubMedGoogle Scholar
  17. 17.
    Hettich R, Koslowski L (1984) Early treatment of burn wounds. Langenbecks Arch Chir 364: 205CrossRefPubMedGoogle Scholar
  18. 18.
    Holder IA, Durkee P, Supp AP, Boyce ST (2003) Assessment of a silver-coated barrier dressing for potential use with skin grafts on excised burns. Burns 29: 445CrossRefPubMedGoogle Scholar
  19. 19.
    Hsueh PR, Teng LJ, Yang PC et al. (1998) Persistence of a multidrug-resistant Pseudomonas aeruginosa clone in an intensive care burn unit. J Clin Microbiol 36: 1347PubMedGoogle Scholar
  20. 20.
    Hunziker T (2004) Autologous cultured skin substitutes. Hautarzt 55: 1077PubMedGoogle Scholar
  21. 21.
    Kirsner RS (1998) The use of Apligraf in acute wounds. J Dermatol 25: 805PubMedGoogle Scholar
  22. 22.
    Kistler D, Eren S, Hettich R (1989) Burns. Primary management and clinical therapy. Versicherungsmedizin 41: 116PubMedGoogle Scholar
  23. 23.
    Klein MB, Engrav LH, Holmes JH et al. (2005) Management of facial burns with a collagen/glycosaminoglycan skin substitute-prospective experience with 12 consecutive patients with large, deep facial burns. Burns 31: 257CrossRefPubMedGoogle Scholar
  24. 24.
    Kolokythas P, Vogt PM (2006) Aktuelle Hautersatzmaterialien in der Vrebrennungsmedizin. Plast Chir 2: 25Google Scholar
  25. 25.
    Konigova R, Matouskova E, Broz L (2000) Burn wound coverage and burn wound closure. Acta Chir Plast 42: 64PubMedGoogle Scholar
  26. 26.
    Kramer A, Roth B, Muller G et al. (2004) Influence of the antiseptic agents polyhexanide and octenidine on FL cells and on healing of experimental superficial aseptic wounds in piglets. A double-blind, randomised, stratified, controlled, parallel-group study. Skin Pharmacol Physiol 17: 141CrossRefPubMedGoogle Scholar
  27. 27.
    Kreis RW, Mackie DP, Vloemans AW et al. (1993) Widely expanded postage stamp skin grafts using a modified Meek technique in combination with an allograft overlay. Burns 19: 142CrossRefPubMedGoogle Scholar
  28. 28.
    Kreis RW, Vloemans AF, Hoekstra MJ et al. (1989) The use of non-viable glycerol-preserved cadaver skin combined with widely expanded autografts in the treatment of extensive third-degree burns. J Trauma 29: 51PubMedGoogle Scholar
  29. 29.
    Kumar RJ, Kimble RM, Boots R, Pegg SP (2004) Treatment of partial-thickness burns: a prospective, randomized trial using Transcyte. ANZ J Surg 74: 622CrossRefPubMedGoogle Scholar
  30. 30.
    Langer S, Botteck NM, Bosse B et al. (2006) Effect of polyvinylpyrrolidone-iodine liposomal hydrogel on wound microcirculation in SKH1-hr hairless mice. Eur Surg Res 38: 27CrossRefPubMedGoogle Scholar
  31. 31.
    Levine N, Seifter E, Connerton C, Levenson SM (1973) Débridement of experimental skin burns of pigs with bromelain, a pineapple-stem enzyme. Plast Reconstr Surg 52: 413PubMedGoogle Scholar
  32. 32.
    Levine NS, Salisbury RE, Mason AD Jr (1975) The effect of early surgical excision and homografting on survival of burned rats and of intraperitoneally-infected burned rats. Plast Reconstr Surg 56: 423CrossRefPubMedGoogle Scholar
  33. 33.
    Maggi SP, Soler PM, Smith PD et al. (1999) The efficacy of 5% Sulfamylon solution for the treatment of contaminated explanted human meshed skin grafts. Burns 25: 237CrossRefPubMedGoogle Scholar
  34. 34.
    Mansbridge J (1998) Skin substitutes to enhance wound healing. Expert Opin Investig Drugs 7: 803CrossRefPubMedGoogle Scholar
  35. 35.
    Monafo WW, Robinson HN (1977) The treatment of burned children. Clin Plast Surg 4: 537PubMedGoogle Scholar
  36. 36.
    Monafo WW, Tandon SN, Ayvazian VH et al. (1976) Cerium nitrate: a new topical antiseptic for extensive burns. Surgery 80: 465PubMedGoogle Scholar
  37. 37.
    Munster AM (1996) Cultured skin for massive burns. A prospective, controlled trial. Ann Surg 224: 372CrossRefPubMedGoogle Scholar
  38. 38.
    Nave M (1992) Wound bed preparation: approaches to replacement of dermis. J Burn Care Rehabil 13: 147CrossRefPubMedGoogle Scholar
  39. 39.
    Orgill DP, Liu PY, Ritterbush LS et al. (1996) Débridement of porcine burns with a highly purified, ananain-based cysteine protease preparation. J Burn Care Rehabil 17: 311CrossRefPubMedGoogle Scholar
  40. 40.
    Pierer H (1966) Primary excision in burns. Klin Med Osterr Z Wiss Prakt Med 21: 377PubMedGoogle Scholar
  41. 41.
    Purdue GF, Hunt JL, Still JM et al. (1997) A multicenter clinical trial of a biosynthetic skin replacement, Dermagraft-TC, compared with cryopreserved human cadaver skin for temporary coverage of excised burn wounds. J Burn Care Rehabil 18 Pt 1: 52CrossRefGoogle Scholar
  42. 42.
    Reimer K, Vogt PM, Broegmann B et al. (2000) An innovative topical drug formulation for wound healing and infection treatment: in vitro and in vivo investigations of a povidone-iodine liposome hydrogel. Dermatology 201: 235CrossRefPubMedGoogle Scholar
  43. 43.
    Ryan CM, Schoenfeld DA, Malloy M et al. (2002) Use of Integra artificial skin is associated with decreased length of stay for severely injured adult burn survivors. J Burn Care Rehabil 23: 311CrossRefPubMedGoogle Scholar
  44. 44.
    Sheridan R, Choucair R, Donelan M et al. (1998) A cellular allodermis in burns surgery: 1-year results of a pilot trial. J Burn Care Rehabil 19: 528PubMedGoogle Scholar
  45. 45.
    Silver S, Phung le T, Silver G (2006) Silver as biocides in burn and wound dressings and bacterial resistance to silver compounds. J Ind Microbiol Biotechnol 33: 627CrossRefPubMedGoogle Scholar
  46. 46.
    Tsipouras N, Rix CJ, Brady PH (1995) Solubility of silver sulfadiazine in physiological media and relevance to treatment of thermal burns with silver sulfadiazine cream. Clin Chem 41: 87PubMedGoogle Scholar
  47. 47.
    Uhlig C, Rapp M, Hartmann B et al. (2006) Suprathel – An innovative, resorbable skin substitute for the treatment of burn victims. Burns 33: 221CrossRefPubMedGoogle Scholar
  48. 48.
    Vogt PM, Hauser J, Rossbach O et al. (2001) Polyvinyl pyrrolidone-iodine liposome hydrogel improves epithelialization by combining moisture and antisepis. A new concept in wound therapy. Wound Repair Regen 9: 116CrossRefPubMedGoogle Scholar
  49. 49.
    Vogt PM, Reimer K, Hauser J et al. (2006) PVP-iodine in hydrosomes and hydrogel: a novel concept in wound therapy leads to enhanced epithelialization and reduced loss of skin grafts. Burns 32: 698CrossRefPubMedGoogle Scholar
  50. 50.
    Waymack P, Duff RG, Sabolinski M (2000) The effect of a tissue engineered bilayered living skin analog, over meshed split-thickness autografts on the healing of excised burn wounds. The Apligraf Burn Study Group. Burns 26: 609CrossRefPubMedGoogle Scholar
  51. 51.
    Wisser D, Steffes J (2003) Skin replacement with a collagen based dermal substitute, autologous keratinocytes and fibroblasts in burn trauma. Burns 29: 375PubMedGoogle Scholar
  52. 52.
    Wood F (2003) Clinical potential of autologous epithelial suspension. Wounds 15: 16Google Scholar
  53. 53.
    Wood FM, Kolybaba ML, Allen P (2006) The use of cultured epithelial autograft in the treatment of major burn wounds: eleven years of clinical experience. Burns 32: 538CrossRefPubMedGoogle Scholar
  54. 54.
    Wood FM, Stoner M (1996) Implication of basement membrane development on the underlying scar in partial-thickness burn injury. Burns 22: 459CrossRefPubMedGoogle Scholar
  55. 55.
    Zhang ML, Chang ZD, Wang CY, Fang CH (1988) Microskin grafting in the treatment of extensive burns: a preliminary report. J Trauma 28: 804PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • P.M. Vogt
    • 1
  • P. Kolokythas
    • 1
  • A. Niederbichler
    • 1
  • K. Knobloch
    • 1
  • K. Reimers
    • 1
  • C.Y. Choi
    • 1
  1. 1.Klinik und Poliklinik für Plastische, Hand- und Wiederherstellungschirurgie,Zentrum für SchwerbrandverletzteMedizinische Hochschule HannoverHannoverDeutschland

Personalised recommendations