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Pathophysiologie der Wundheilung und modernes Wundmanagement im urologischen Kontext

Pathophysiology of wound healing and current treatment strategies in a urological context

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Zusammenfassung

Akute Wundheilung ist ein dynamischer, interaktiver Prozess, an dessen Ende der Defektverschluss steht. Störungen des Heilungsablaufs führen zu chronischen Wunden. Proteasen bauen wichtige Wachstumsfaktoren und Matrixproteine ab, die Entzündung wird unterhalten, ein zeitgerechter, ungestörter Wundschluss unterbleibt. Aufgrund der demografischen Entwicklung wird die Erforschung altersassoziierter Erkrankungen, zu denen auch chronische, therapierefraktäre Wunden gehören, immer wichtiger. Das TIME-Konzept („tissue, infection, moisture imbalance, edge of wound“) beschreibt wesentliche Elemente des Heilungsprozesses, die bei therapierefraktären Wunden therapeutisch angegangen werden können. Die feuchte Wundbehandlung ist Standardtherapie. Konklusive Untersuchungen zu den Erfolgen einzelner Wundauflagen stehen noch aus. Neue Therapieformen sollten neben klinischen Variablen auch die Lebensqualität, die Unabhängigkeit der Patienten von externer Hilfe und ökonomische Aspekte beinhalten.

Abstract

Acute wound healing is a dynamic, interactive process culminating in the closure of a tissue defect. Chronic wounds result when the healing cascade is impaired. Proteases destroy important growth factors and matrix proteins, inflammation is prolonged, and the normal healing process does not take place within the expected time span. Owing to demographic changes the investigation of age-related pathologies, including treatment-resistant wounds, has become increasingly important. The TIME concept (tissue, infection, moisture imbalance, edge of wound) assesses essential elements in the healing process that can be addressed in the treatment of chronic wounds. Moist wound treatment is standard therapy. Definitive research trials on the level of success that can be achieved with different dressings are still needed. New types of treatment should be selected with due consideration for clinical variables, the patient’s quality of life and independence, and cost effectiveness.

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Authors and Affiliations

  1. Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland

    C. Wicke & A. Königsrainer

  2. Klinik für Urologie, Universitätsklinikum Tübingen, Tübingen, Deutschland

    D. Schilling, S. Feyerabend & A. Stenzl

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  1. C. Wicke
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  2. D. Schilling
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  3. S. Feyerabend
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  4. A. Königsrainer
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  5. A. Stenzl
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Correspondence to C. Wicke.

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Wicke, C., Schilling, D., Feyerabend, S. et al. Pathophysiologie der Wundheilung und modernes Wundmanagement im urologischen Kontext. Urologe 46, 1721–1734 (2007). https://doi.org/10.1007/s00120-007-1593-1

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  • DOI: https://doi.org/10.1007/s00120-007-1593-1

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