Skip to main content
SpringerLink
Log in

Schwierige Weichteilverhältnisse

Einfluss der Komorbidität auf Diagnostik und Behandlung

Problematic soft tissue conditions

Influence of comorbidities on diagnostics and therapy

  • Übersichten
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Patienten mit Wundheilungsstörungen und problematischen Weichteilverhältnissen nach stattgehabten Verletzungen bzw. im Anschluss an operative Eingriffe stellen eine alltägliche Herausforderung für den behandelnden Unfallchirurgen dar. Die Reparaturprozesse, die im Rahmen der Wundheilung ablaufen, unterliegen vielfältigen lokalen und systemischen Einflüssen. Für den Chirurgen ist es von zentraler Bedeutung, diese verschiedenen Einflussfaktoren und ihre Wirkung zu kennen, um sie optimieren zu können und einen möglichst reibungslosen Heilungsverlauf zu fördern. Gerade bei der stetig zunehmenden Zahl der älteren Patienten spielen die begleitenden Komorbiditäten eine wichtige Rolle im Heilungsverlauf. Es wird ein Überblick über die wichtigsten Einflussfaktoren und die relevante Literatur gegeben.

Abstract

Patients with impaired wound healing and problematic soft tissue conditions after traumatic injury or following surgery present a daily challenge to the attending trauma surgeon. The repair process in wound healing is affected by a variety of local and systemic factors. For the surgeon it is very important to know about these factors and their effects on the process of wound healing to promote unimpaired tissue repair. With a steadily increasing number of elder patients, comorbidities play an essential role in the healing process. This article gives a review of the most important factors affecting tissue repair and the relevant literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Ahn C, Mulligan P, Salcido RS (2008) Smoking-the bane of wound healing: biomedical interventions and social influences. Adv Skin Wound Care 21:227–237

    Article  PubMed  Google Scholar 

  2. Anaya DA, Dellinger EP (2006) The obese surgical patient: a susceptible host for infection. Surg Infect (Larchmt) 7:473–480

    Google Scholar 

  3. Bishop A (2008) Role of oxygen in wound healing. J Wound Care 17:399–402

    PubMed  CAS  Google Scholar 

  4. Bjarnsholt T, Kirketerp-Moller K, Jensen PO et al (2008) Why chronic wounds will not heal: a novel hypothesis. Wound Repair Regen 16:2–10

    Article  PubMed  Google Scholar 

  5. Brem H, Tomic-Canic M (2007) Cellular and molecular basis of wound healing in diabetes. J Clin Invest 117:1219–1222

    Article  PubMed  CAS  Google Scholar 

  6. Calabro P, Yeh ET (2007) Obesity, inflammation and vascular disease: the role of the adipose tissue as an endocrine organ. Subcell Biochem 42:63–91

    Article  PubMed  Google Scholar 

  7. Chan LK, Withey S, Butler PE (2006) Smoking and wound healing problems in reduction mammaplasty: is the introduction of urine nicotine testing justified? Ann Plast Surg 56:111–115

    Article  PubMed  CAS  Google Scholar 

  8. Choudhry MA, Chaudry IH (2006) Alcohol intoxication and post-burn complications. Front Biosci 11:998–1005

    Article  PubMed  CAS  Google Scholar 

  9. Davis SC, Ricotti C, Cazzaniga A et al (2008) Microscopic and physiologic evidence for biofilm-associated wound colonization in vivo. Wound Repair Regen 16:23–29

    Article  PubMed  Google Scholar 

  10. Dong YL, Fleming RY, Yan TZ et al (1993) Effect of ibuprofen on the inflammatory response to surgical wounds. J Trauma 35:340–343

    Article  PubMed  CAS  Google Scholar 

  11. Dvivedi S, Tiwari SM, Sharma A (1997) Effect of ibuprofen and diclofenac sodium on experimental wound healing. Indian J Exp Biol 35:1243–1245

    PubMed  CAS  Google Scholar 

  12. Edwards R, Harding KG (2004) Bacteria and wound healing. Curr Opin Infect Dis 17:91–96

    Article  PubMed  Google Scholar 

  13. Emery CF, Kiecolt-Glaser JK, Glaser R et al (2005) Exercise accelerates wound healing among healthy older adults: a preliminary investigation. J Gerontol A Biol Sci Med Sci 60:1432–1436

    Article  PubMed  Google Scholar 

  14. Fitzgerald DJ, Radek KA, Chaar M et al (2007) Effects of acute ethanol exposure on the early inflammatory response after excisional injury. Alcohol Clin Exp Res 31:317–323

    Article  PubMed  CAS  Google Scholar 

  15. Fontana L, Eagon JC, Colonna M, Klein S (2007) Impaired mononuclear cell immune function in extreme obesity is corrected by weight loss. Rejuvenation Res 10:41–46

    Article  PubMed  Google Scholar 

  16. Franz MG, Steed DL, Robson MC (2007) Optimizing healing of the acute wound by minimizing complications. Curr Probl Surg 44:691–763

    Article  PubMed  Google Scholar 

  17. Galkowska H, Olszewski WL, Wojewodzka U et al (2006) Neurogenic factors in the impaired healing of diabetic foot ulcers. J Surg Res 134:252–258

    Article  PubMed  CAS  Google Scholar 

  18. Gallagher KA, Liu ZJ, Xiao M et al (2007) Diabetic impairments in NO-mediated endothelial progenitor cell mobilization and homing are reversed by hyperoxia and SDF-1 alpha. J Clin Invest 117:1249–1259

    Article  PubMed  CAS  Google Scholar 

  19. Gentilello LM, Cobean RA, Walker AP et al (1993) Acute ethanol intoxication increases the risk of infection following penetrating abdominal trauma. J Trauma 34:669–674

    Article  PubMed  CAS  Google Scholar 

  20. Gosain A, DiPietro LA (2004) Aging and wound healing. World J Surg 28:321–326

    Article  PubMed  Google Scholar 

  21. Greco JA 3rd, Castaldo ET, Nanney LB et al (2008) The effect of weight loss surgery and body mass index on wound complications after abdominal contouring operations. Ann Plast Surg 61:235–242

    Article  PubMed  CAS  Google Scholar 

  22. Greiffenstein P, Molina PE (2008) Alcohol-induced alterations on host defense after traumatic injury. J Trauma 64:230–240

    Article  PubMed  Google Scholar 

  23. Hofman D, Moore K, Cooper R et al (2007) Use of topical corticosteroids on chronic leg ulcers. J Wound Care 16:227–230

    PubMed  CAS  Google Scholar 

  24. Jones MK, Wang H, Peskar BM et al (1999) Inhibition of angiogenesis by nonsteroidal anti-inflammatory drugs: insight into mechanisms and implications for cancer growth and ulcer healing. Nat Med 5:1418–1423

    Article  PubMed  CAS  Google Scholar 

  25. Juge-Aubry CE, Henrichot E, Meier CA (2005) Adipose tissue: a regulator of inflammation. Best Pract Res Clin Endocrinol Metab 19:547–566

    Article  PubMed  CAS  Google Scholar 

  26. Keylock KT, Vieira VJ, Wallig MA et al (2008) Exercise accelerates cutaneous wound healing and decreases wound inflammation in aged mice. Am J Physiol Regul Integr Comp Physiol 294:R179–R184

    Article  PubMed  CAS  Google Scholar 

  27. Krischak GD, Augat P, Claes L et al (2007) The effects of non-steroidal anti-inflammatory drug application on incisional wound healing in rats. J Wound Care 16:76–78

    PubMed  CAS  Google Scholar 

  28. Kurth BM, Schaffrath Rosario A (2007) The prevalence of overweight and obese children and adolescents living in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 50:736–743

    Article  Google Scholar 

  29. Lauerman CJ (2008) Surgical patient education related to smoking. AORN J 87:599–609

    Article  PubMed  Google Scholar 

  30. Madan AK, Yu K, Beech DJ (1999) Alcohol and drug use in victims of life-threatening trauma. J Trauma 47:568–571

    Article  PubMed  CAS  Google Scholar 

  31. McMaster SK, Paul-Clark MJ, Walters M et al (2008) Cigarette smoke inhibits macrophage sensing of gram-negative bacteria and lipopolysaccharide: relative roles of nicotine and oxidant stress. Br J Pharmacol 153:536–543

    Article  PubMed  CAS  Google Scholar 

  32. Mello VD de, Kolehmainen M, Schwab U et al (2008) Effect of weight loss on cytokine messenger RNA expression in peripheral blood mononuclear cells of obese subjects with the metabolic syndrome. Metabolism 57:192–199

    Article  PubMed  Google Scholar 

  33. Menke NB, Ward KR, Witten TM et al (2007) Impaired wound healing. Clin Dermatol 25:19–25

    Article  PubMed  Google Scholar 

  34. Momeni A, Heier M, Bannasch H, Stark GB (2009) Complications in abdominoplasty: a risk factor analysis. J Plast Reconstr Aesthet Surg 62:1250–1254

    Article  PubMed  Google Scholar 

  35. Nieman DC, Henson DA, Nehlsen-Cannarella SL et al (1999) Influence of obesity on immune function. J Am Diet Assoc 99:294–299

    Article  PubMed  CAS  Google Scholar 

  36. Quattrini C, Jeziorska M, Boulton AJ, Malik RA (2008) Reduced vascular endothelial growth factor expression and intra-epidermal nerve fiber loss in human diabetic neuropathy. Diabetes Care 31:140–145

    Article  PubMed  Google Scholar 

  37. Radek KA, Matthies AM, Burns AL et al (2005) Acute ethanol exposure impairs angiogenesis and the proliferative phase of wound healing. Am J Physiol Heart Circ Physiol 289:H1084–H1090

    Article  PubMed  CAS  Google Scholar 

  38. Radek KA, Kovacs EJ, DiPietro LA (2007) Matrix proteolytic activity during wound healing: modulation by acute ethanol exposure. Alcohol Clin Exp Res 31:1045–1052

    Article  PubMed  CAS  Google Scholar 

  39. Radek KA, Kovacs EJ, Gallo RL, DiPietro LA (2008) Acute ethanol exposure disrupts VEGF receptor cell signaling in endothelial cells. Am J Physiol Heart Circ Physiol 295:H174–H184

    Article  PubMed  CAS  Google Scholar 

  40. Rivara FP, Jurkovich GJ, Gurney JG et al (1993) The magnitude of acute and chronic alcohol abuse in trauma patients. Arch Surg 128:907–912

    PubMed  CAS  Google Scholar 

  41. Rodriguez PG, Felix FN, Woodley DT, Shim EK (2008) The role of oxygen in wound healing: a review of the literature. Dermatol Surg 34:1159–1169

    Article  PubMed  CAS  Google Scholar 

  42. Sorensen LT, Karlsmark T, Gottrup F (2003) Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg 238:1–5

    PubMed  Google Scholar 

  43. Sorensen LT, Jorgensen LN, Zillmer R et al (2006) Transdermal nicotine patch enhances type I collagen synthesis in abstinent smokers. Wound Repair Regen 14:247–251

    Article  PubMed  Google Scholar 

  44. Sorensen LT, Jorgensen S, Petersen LJ et al (2009) Acute effects of nicotine and smoking on blood flow, tissue oxygen and aerobe metabolism of the skin and subcutis. J Surg Res 152:224–230

    Article  PubMed  CAS  Google Scholar 

  45. Swift ME, Kleinman HK, DiPietro LA (1999) Impaired wound repair and delayed angiogenesis in aged mice. Lab Invest 79:1479–1487

    PubMed  CAS  Google Scholar 

  46. Swift ME, Burns AL, Gray KL, DiPietro LA (2001) Age-related alterations in the inflammatory response to dermal injury. J Invest Dermatol 117:1027–1035

    Article  PubMed  CAS  Google Scholar 

  47. Szabo G, Mandrekar P (2009) A recent perspective on alcohol, immunity and host defense. Alcohol Clin Exp Res 33:220–232

    Article  PubMed  CAS  Google Scholar 

  48. Tandara AA, Mustoe TA (2004) Oxygen in wound healing – more than a nutrient. World J Surg 28:294–300

    Article  PubMed  Google Scholar 

  49. Wilson JA, Clark JJ (2004) Obesity: impediment to postsurgical wound healing. Adv Skin Wound Care 17:426–435

    Article  PubMed  Google Scholar 

  50. Wozniak SE, Gee LL, Wachtel MS, Frezza EE (2009) Adipose tissue: the new endocrine organ? A review article. Dig Dis Sci 54:1847–1856

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Unfall-, Wiederherstellungs- und Handchirurgie, Städtisches Klinikum Dresden-Friedrichstadt, Akademisches Lehrkrankenhaus der Technischen Universität Dresden, Friedrichstraße 41, 01067, Dresden, Deutschland

    P. Bula & F. Bonnaire

Authors
  1. P. Bula
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Bonnaire
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Bula.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bula, P., Bonnaire, F. Schwierige Weichteilverhältnisse. Trauma Berufskrankh 13 (Suppl 1), 12–19 (2011). https://doi.org/10.1007/s10039-010-1641-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-010-1641-8

Schlüsselwörter

Keywords

Search

Navigation