[The non-healing wound]

Abstract

The most common chronic wounds are pressure ulcers, diabetic ulcers, arterial occlusive disease and venous ulcers. The therapeutic aim after appropriate diagnostic work-up is causal treatment. Pressure relief, revascularisation or compression head the list of potential measures. Apart from local factors such as infection or necrosis, systemic factors such as patient compliance, renal insufficiency and immunosuppression are of relevance. If there is a chance of healing, wound management comprises repeated debridement and wet dressings. In the presence of an infection, local antiseptic treatment is indicated. In the individual case, wound stimulation can be supported by protease inhibitors, growth factors or tissue engineering. Definitive wound closure is achieved by epithelial migration from the margins of the wound, or by plastic surgery. Regular documentation of the course and success of wound healing is mandatory. In the wound care center, surgical disciplines, diabetology, dermatology and diagnostic work-up are coordinated, and liaison with the family doctor and home care providers practiced. This wound healing concept successfully heals approximately 80% of the cases of chronic wounds in 18.8 months (mean healing duration 4.8 months).