Der Unfallchirurg

, Volume 112, Issue 6, pp 543–549 | Cite as

Hautersatzverfahren in der Verbrennungschirurgie

Leitthema

Zusammenfassung

Bei großflächigen Verbrennungen ist es häufig nicht möglich, nach der Nekrektomie in gleicher Sitzung die autologe Spalthauttransplantation durchzuführen. Um den Wasser- und Proteinverlust zu reduzieren, werden die Wunden mit einem temporären Hautersatz abgedeckt. Für die temporäre Wundabdeckung großflächig nekrektomierter Verbrennungswunden stehen allogene und xenogene Haut sowie synthetische Materialien wie Polyurethanschwämme zur Verfügung.

Zur Verbesserung der langfristigen Ergebnisse der Spalthauttransplantation mit Reduktion der Kontraktur und Verbesserung der Elastizität erfolgt die zusätzliche Transplantation von dermalem Hautersatz. Mehrere azelluläre Produkte (Kollagen-Glykosaminoglycanmatrix, azelluläre allogene Dermis, lyophilisierte Kollagen-Elastin-Matrix) sind kommerziell erhältlich. Bisher konnte mit keinem dieser Hautersatzmateralien eine Regeneration der Dermis erreicht werden. Dennoch sind diese Materialien geeignet, das Wundbett und damit das abschließende Ergebnis nach Spalthauttransplantation zu verbessern.

Schlüsselwörter

Hautersatz Verbrennung Dermis Allogen 

Skin graft procedures in burn surgery

Abstract

Patients with extensive deep partial or full thickness burns require early excision of necrotic tissue, however, in many of these cases simultaneous autografting is not possible due to the general condition of the patient. In this instance temporary dressings like allogeneic or xenogeneic skin or foam dressings can be applied to minimize fluid and protein loss. In Europe glycerolized preserved allogeneic skin remains the treatment standard.

Dermal replacements are considered to optimize the long-term outcome of split thickness skin grafting. Reduced contracture rates and increased pliability have been reported after additional dermal enhancement with either collagen-glycosaminoglycan matrix, acellular allogeneic dermis or collagen/elastin matrix. True regeneration of the dermis has not yet been observed. However, these materials are suitable for improvement of the wound bed and also the final result after split thickness skin transplantation.

Keywords

Skin substitute Burn Dermis Allogeneic 

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Klinik für Plastische, Hand- und WiederherstellungschirurgieMedizinische Hochschule HannoverHannoverDeutschland

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