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Wundunterdrucktherapie bei Schwerbrandverletzten

Negative pressure wound therapy for severe burn injuries

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Trauma und Berufskrankheit

Zusammenfassung

Mittels Wundunterdrucktherapie lassen sich chirurgische, traumatische und chronische Wunden konditionieren. Ihre konzeptionelle, auch großflächige Anwendung insbesondere bei Schwer- und Schwerstbrandverletzten wurde in den vergangen 3 Jahren am Brandverletztenzentrum der Unfallklinik Murnau konsequent verfolgt. Von der Initialversorgung nach Blasendébridement über die Phase der Wundkonditionierung nach Nekrosedébridement bis zur Spalthautübertragung wurden 48 Patienten mit einer brandverletzten Körperoberfläche bis zu 90% mittels Wundunterdrucktherapie behandelt. Intensivmedizinische und chirurgische Parameter der Wundheilung wurden über den gesamten Verlauf des intensivmedizinischen Aufenthalts bestimmt. Bei allen mittels Wundunterdruckverbänden behandelten Patienten konnten unter deutlicher Reduktion der notwendigen Verbandwechsel eine hervorragende Wundkonditionierung, nach Spalthauttransplantation ein rascherer Wundverschluss erreicht werden, zudem waren sie hinsichtlich der intensivmedizinischen und chirurgischen Parameter stabiler. Der konsequente Einsatz der Wundunterdrucktherapie von der Initialversorgung bis zur definitiven Defektdeckung erwies sich somit bislang als exzellentes Therapiekonzept.

Abstract

Negative pressure wound therapy has been used for many years for surgical, traumatic and chronic lesions. During the last 3 years negative pressure wound therapy was consistently pursued as a concept in adults with severe burn injuries in the burn center at the trauma center in Murnau. A total of 48 patients with severe burn injuries to a total body surface area (TBSA) of up to 90% were treated with negative pressure wound therapy. This therapy was used during all stages of treatment from the initial phases of debridement to split thickness skin grafting after debridement. Intensive care parameters and surgical parameters of tissue repair were recorded during the whole intensive care phase. These parameters were compared to data of burn patients who received conservative therapy. All patients with severe burn injuries treated with negative pressure wound therapy showed a significant reduction in redressing. Furthermore, outstanding wound conditioning and excellent take rates after split thickness skin grafting were observed. Intensive care parameters and surgical parameters of wound healing showed patients treated with negative pressure wound therapy were more stable in comparison to patients treated conservatively. Negative pressure wound therapy was shown to be an excellent option especially in the treatment of severe burn patients from initial debridement to final split skin grafting.

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Literatur

  1. Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 38:563–567

    Article  PubMed  CAS  Google Scholar 

  2. Arturson G (1979) Microvascular permeability of macromolecules in thermal injury. Acta Physiol Scand [Suppl] 463:111–122

    Google Scholar 

  3. Arturson G, Mellander S (1962) Acute changes in capillary filtration and diffusion in experimental burn injury. Acta Physiol Scand 62:457–463

    Article  Google Scholar 

  4. Barillo DJ, Paulsen S (2003) Management of burns to the hand. Wounds 15:4–9

    Google Scholar 

  5. Blackburn II JH, Boemi L, Hall WW (1998) Negative-pressure dressings as a bolster for skin grafts. Ann Plast Surg 40:453–457

    Article  PubMed  Google Scholar 

  6. Camara DL de, Raine TJ, London MD et al (1982) Progression of thermal injury: a morphological study. Plast Reconstr Surg 69:491–499

    Article  Google Scholar 

  7. Hineshaw RJ (1963) Early changes in the depth of burns. Arch Surg 87:131–135

    Google Scholar 

  8. Jackson DM (1953) The diagnosis of the depth of burning. Br J Surg 40:588–596

    Article  PubMed  CAS  Google Scholar 

  9. Kamolz LP, Andel H, Haslik W et al (2004) Use of subatmospheric pressure therapy to prevent burn wound progression in human: first experiences. Burns 30:253–258

    Article  PubMed  Google Scholar 

  10. Morykwas MJ, Argenta LC (1997) Vacuum-assisted closure: a new method for wound control and treatment. Animal study. Ann Plast Surg 212–213

  11. Morykwas MJ, David LR, Schneider AM et al (1999) Use of subatmospheric pressure to prevent progression of partial-thickness burns in a swine model. J Burn Care Rehabil 20:15–21

    PubMed  CAS  Google Scholar 

  12. Noble HGS, Robson MC, Krizek TJ (1977) Dermal ischemia in the burn wound. J Surg Res 23:117–125

    Article  PubMed  CAS  Google Scholar 

  13. Nozaki ML, Guest MM, Bond TP et al (1979) Permeability of blood vessels after thermal injury. Burns 6:213–221

    Article  Google Scholar 

  14. Scherer LA, Shiver S, Chang M et al (2002) The vacuum assisted closure device. Arch Surg 137:930–934

    Article  PubMed  Google Scholar 

  15. Schneider AM, Morykwas MJ, Argenta LC (1998) A new and reliable method of securing skin grafts to the difficult recipient bed. Plast Reconstr Surg 102:1195–1198

    Article  PubMed  CAS  Google Scholar 

  16. Schrank C, Mayr M, Overesch M et al (2004) Ergebnisse der Vakuumtherapie (V.A.C.®-Therapie) von oberflächlichen und tiefdermalen Verbrennungen. Zentralbl Chir 129:59–61

    Article  Google Scholar 

  17. Sevitt S (1949) Local blood flow changes in experimental burns. J Pathol Bacteriol 61:427–442

    Article  Google Scholar 

  18. Sposato G, Molea G, Di Caprio G (2001) Ambulant vacuum-assisted closure of skin-graft dressing in the lower limbs using a portable mini-VAC device. Br J Plast Surg 54:235–237

    Article  PubMed  CAS  Google Scholar 

  19. Willy C, Gerngross H (2004) Der wissenschaftliche Hintergrund der Vakuumversiegelung – Eine Übersicht. Zentralbl Chir 129:6

    Article  Google Scholar 

  20. Zawacki BE (1974) The natural history of reversible burn injury. Surg Gynecol Obstet 139:867–872

    PubMed  CAS  Google Scholar 

  21. Zawacki BE (1987) The local effects of burn injury. In: Boswick JA (Hrsg) The art and science of burn care. Aspen, Rockville, S 25–36

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Öhlbauer, M., Wallner, B. & Sauermüller, G. Wundunterdrucktherapie bei Schwerbrandverletzten. Trauma Berufskrankh 13 (Suppl 1), 157–163 (2011). https://doi.org/10.1007/s10039-011-1742-z

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