Chronic Wound: Therapy

The therapy of chronic wounds depends on the exact cause. Caution!Therapy-resistant or morphologically conspicuous ulcerations (ulcers) must be clarified histologically (fine tissue)! For specific recommendations on pressure ulcers or diabetic foot, see under the respective clinical picture.

General measures

  • Aim for normal weight!Determine BMI (body mass index) or body composition using electrical impedance analysis.
    • Falling below the BMI lower limit (from the age of 19: 19; from the age of 25: 20; from the age of 35: 21; from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
  • Nicotine restriction (refraining from tobacco use).

Conventional non-surgical therapy methods

Concomitant measures (local wound treatment)

  • Procedure as follows:
    1. Debridement (wound toilet): to allow the wound to heal, avital (dead) tissue as well as foreign bodies should be removed during debridement. In addition to surgical treatment, the use of ultrasound or hydrotherapy is possible. Also, maggots are increasingly used.
    2. Granulation: granulation (visible appearance of granular structures) is supported by moist wound dressings. Various agents such as activated carbon or alginate are used.
    3. Epithelialization: wound closure using split-thickness skin grafts is the first-line therapy for chronic wounds.
  • Vacuum therapy (vacuum sealing therapy (VVS); vacuum-assisted closure technique, VAC; “negative pressure wound therapy,” NPWT) – suction between 50 and 200 mmHg:
    • Wound edema is reduced
    • Wound contraction
    • Tactile stimulus
    • Improved capillary blood flow
    • Vacuum therapy may be recommended for supply-related wound replenishment and wound depth/volume reduction.

    The Institute for Quality and Efficiency in Health Care (IQWiG) sees secondary wound healing with vacuum sealing therapy (VVS) in its final report an “indication” of a higher benefit compared to standard treatment.

  • Wound irrigation using sterile products; chemical additives are not recommended; use of antiseptics may be considered for inflammation that is pathogen-related
  • Hydrogels are recommended as needed in diabetic foot syndrome, venous leg ulcers and arteriosum
  • Wound dressings with the following criteria can be recommended: Practicability, adhesive strength, absorption and retention of exudate, avoidance of maceration (softening of the tissue), avoidance of pain. It should be noted:
    • Is dry necrosis (tissue damage; death of cells) present? → Keep necrosis dry
    • Strong or balanced exudate (wound fluid) → protect wound edge and wound environment; avoid fluid leakage from dressing.
    • Weak exudate emergence → avoidance of dryness-related disadvantages (e.g., pain).
  • Hyperbaric oxygenation (HBO; synonyms: hyperbaric oxygen therapy, HBO therapy; English : hyperbaric oxygen therapy; HBO2, HBOT); therapy in which medically pure oxygen is applied under an elevated ambient pressure – is used in out-treated amputation-prone wounds in diabetic foot syndrome.
  • The use of honey can not be recommended
  • Silver-containing wound dressings show no advantage in studies

Vaccinations

The following vaccinations are advised:

  • Flu vaccination
  • Pneumococcal vaccination

Regular checkups

  • Regular medical checkups

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
  • Observance of the following special dietary recommendations:
    • Diet rich in:
      • Vitamins (vitamin C, folate)
      • Trace elements (iron, selenium, zinc)
      • Omega-3 fatty acids (marine fish)
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Complementary treatment methods

  • Magnetic field therapy – can be used adjunctively for venous ulcers.
  • Low-frequency conduction ultrasound – no sufficient studies available.
  • Low frequency direct current pulses – no sufficient studies available.
  • Extracorporeal shock waves – no sufficient studies available.
  • Water-filtered infrared light – no sufficient studies available.
  • Laser therapy – no sufficient studies available
  • Compression therapy (including phlebological compression bandage (PKV)) and interventional therapies – for leg ulcer (synonyms: lower leg ulcer, “open leg“).