Wound management in the epithelisation phase tissue form islands from which epithelisation can pro-
Well-developed granulation tissue offering the epithelial ceed. Another possibility is the grafting of autologous
cells a moist gliding surface is the prerequisite for the and in vitro cultured keratinocytes. These keratinocyte
mitosis and migration of epithelial cells. The most impor- cultures are prepared by isolating keratinocytes from a
tant function of the dressing is therefore to ensure that piece of the patient's skin.
the wound also remains moist during the epithelisation
phase. Again, the ideal product for this purpose is the Therapy-refractory ulcers
hydrogel dressing Hydrosorb or the hydrocolloid dressing If the ulcer refuses to heal despite all endeavours, the
Hydrocoll thin, which was developed especially for therapeutic concept should be reviewed. The following
already epithelised wounds. check list may assist in identifying possible causes of
therapy-refractory ulcers:
An ulcer with a good healing tendency can be recognized ▪ Is the compression therapy being adequately per
from the fact that epithelisation is proceeding inwards formed? If appropriate, change from temporary to per-
from the ulcer margin or enlarging islands of epithelial manent bandages, use stronger compression etc.
tissue are spreading over the ulcer floor. ▪ Are the lesions being treated mixed arterial-venous
ulcers?
Certain topical therapeutic medications which induce ▪ Doppler sonographic evaluation of peripheral blood
scabbing of the ulcer can bring about a type of “spurious circulation, further angiographic diagnostic imaging if
healing”. In most cases these encrustations can easily be required
detached again from the ulcer margin. The yellowish ▪ For arterial hypertension (Martorell ulcer!): treat the
coatings underneath also have to be removed, and only hypertension
then is a prognostic evaluation of the cleansed ulcer floor ▪ Is there latent or overt right ventricular failure (edema
possible. in healthy leg)?
▪ Additional outflow disorders due to secondary lym-
Because of the protracted course of healing, the wound phedema?
margins of chronic ulcerations sometimes tend to epithe- ▪ Arthrogenic stasis syndrome in knee or hip arthrosis?
lise and protrude inwards. Since no further epithelisation ▪ Lack of exercise (“rather run and lie down, sitting and
can then take place from the wound margin, the wound standing are bad”, obesity)?
margins should be refreshed by trimming with a scalpel ▪ Erysipelas, mycotic and/or bacterial superinfection
or sharp scissors. (clinical symptomatology)?
Ulcer grafted with split-thickness ▪
Ulcer of other etiology?
skin (mesh graft 1:1.5)
Like all chronic wounds, venous ulcers also sometimes ▪ Therapy-refractory accompanying eczema: Allergy test-
exhibit a poor tendency to spontaneous epithelisation. If ing.
the wound floor has been sufficiently conditioned, wound ▪ Poorly managed diabetes mellitus (determine HbA1c).
closure by split-thickness skin grafting (mesh graft) or the
Reverdin method may be considered in these cases, espe-
cially for larger wound surfaces. In the Reverdin proce-
dure, the flaps of epidermis applied onto the granulation
Phase-specific wound management [42.43]
Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47