plastische, reconstructieve en esthetische chirurgie - UZ Leuven

stellt eine palliative, nicht kurative Therapiemassnahmedar. Das Risiko eines „Wundrezidivs“ ist abhängig vonder Behandlung der Ulcusursache und dem Einsatzmöglicher weiterer symptomatischer Therapien (z.B.Kompressionstherapie…).HIERNER R., DEGREEF H., VRANCKX J.J., GARMYN M.,MASSAGE P., VAN BRUSSEL M.: Skin grafting and woundhealing – the “dermato-plastic team approach”. Clin.Dermatol., 2005; 23: 343-352.Autologous skin grafts are successfully used to closerecalcitrant chronic wounds especially at the lower leg. Ifwound care is done in a dermato-plastic team approachusing the „integrated concept“, difficulties associatedwith harvesting the skin graft, as well as the complexitiesassociated with inducing closure at the donor and therecipient site can be minimized.In the context of wound healing, skin transplantation canbe regarded as 1) a supportive procedure forepithelialization of the wound surface and 2) mechanicalstability of the wound ground. By placing skin grafts on asurface, central parts are covered much faster withkeratinocytes. Skin (wound) closure is the ultimate goal,as wound closure means infection resistance.Depending on the thickness of the skin graft, differentamount of dermis are transplanted with the overlyingkeratinocytes. The dermal component determines themechanical (resistance to pressure and shear forces,graft shrinkage), functional (sensibility) and aestheticproperties of the graft. Generally speaking, the thickerthe graft the better the mechanical, functional andaesthetic and properties however, the worse its neoandrevascularization.Skin grafts do entirely depend on the re- andneovascularization coming from the wound bed. If thewound bed is seen as a recipient site for tissue graftLEXER`s classification turned out to be of extremevalue. Three grades can be distinguished „good woundconditions“, „moderate wound conditions“, and„insufficient wound conditions“. Given “good woundconditions” skin grafting is feasible. However skinclosure alone might not be sufficient to fulfil the criteria ofsuccessful defect reconstruction. In case of „moderate“or „insufficient wound conditions“ wound bedpreparation is necessary. If wound bed preparation issuccessful and “good wound conditions” can beachieved, skin grafting is possible. If, however thisattempt is unsuccessful and “moderate” or “inadequatewound conditions” are persisting, other methods ofdefect reconstruction such as, local flap transfer, distantflap transfer, free (microvascular) flaps and ultimatelyamputation must be considered.HIERNER R., MATTHEUS H., VAN DEN KERCKHOVE E.:Recommendation for a standardised differential