Physikalische Therapien des chronischen Ulcus cruris

[M.O.I.S.T. concept for the local therapy of chronic wounds]

The treatment of patients with chronic wounds is still an interdisciplinary and interprofessional challenge. The basis of successful therapy for these patients is based on causal treatment of the underlying, pathophysiologically relevant diseases. In addition, however, local wound therapy should always be provided to support wound healing and avoid complications. In order to better structure the multitude of wound products, the M.O.I.S.T. concept was developed by a multidisciplinary expert group of WundDACH, the umbrella organization of German-speaking professional societies. M describes, O oxygenation, I infection control, S support of the healing process and T tissue management.The M.O.I.S.T. concept is intended to provide healthcare professionals a guidance for systematic planning and also for education with regard to the local therapy of patients with chronic wounds. The 2022 update of this concept is now presented here for the first time.

Effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing: A meta-analysis

We performed a meta-analysis to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing. A systematic literature search up to January 2022 was done and 13 studies included 1073 subjects with pressure ulcer wound at the start of the study; 593 of them were using traditional Chinese medicine treatments, and 480 were control for pressure ulcer wound. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to evaluate the effect of Chinese herbal topical medicine, acupuncture, and moxibustion on pressure ulcer wound healing by the dichotomous methods with a random or fixed-influence model. Traditional Chinese medicine treatments had significantly higher complete healing (OR, 5.94; 95% CI, 3.94-8.95, P < .001), and curative ratio post-treatment (OR, 4.79; 95% CI, 2.62-8.76, P < .001) compared with control for subjects with pressure ulcer wound. Traditional Chinese medicine treatments had a significantly higher complete healing and curative ratio post-treatment compared with control for subjects with pressure ulcer wounds. Further studies are needed to validate these findings.

[Modern management of chronic wounds]

The treatment of patients with chronic wounds is a multiprofessional challenge. Based on a comprehensive diagnosis and integrated into a causal treatment concept, patients should always be treated with a modern wound therapy. This wound therapy should try to take into account many different factors such as the wound healing phases, infection status, exudate levels, but also individual patient wishes. Especially in the case of chronic wounds of the lower extremities and edema, compression therapy is also very important for therapy and recurrence prophylaxis. In addition, the pain, which is usually very distressing, should be recorded and adequately treated or avoided. Modern moist wound therapy can then support the healing of patients with chronic wounds, reduce complications and thus improve their quality of life.

Traditional Chinese medicine for pressure ulcer: a meta-analysis

To assess the effect of Traditional Chinese Medicine (TCM) [Chinese herbal medicine ointment (CHMO), acupuncture and moxibustion] on pressure ulcer. In this study, we searched MEDLINE, EMBASE, CENTER, CBM, CNKI, WAN FANG and VIP for articles published from database inception up to 4 April 2011. We included randomised controlled trials (RCTs), which compared the effects of TCM with other interventions. We assessed the methodological quality of these trials using Cochrane risk of bias criteria. Ten of 565 potentially relevant trails that enrolled a total of 893 patients met our inclusion criteria. All the included RCTs only used CHMO intervention, because acupuncture and moxibustion trials failed to meet the inclusive criteria. A meta-analysis showed beneficial effects of CHMO for pressure ulcer compared with other treatments on the total effective rate [risk ratio (RR): 1·28; 95% confidence interval (CI): 1·20-1·36; P = 0·53; I(2) = 0%), curative ratio (RR: 2·02; 95% CI: 1·73-2·35; P = 0·11; I(2) = 37%) and inefficiency rate (RR: 0·16; 95% CI: 0·02-0·80; P = 0·84; I(2) = 0%). However, the funnel plot indicated that there was publication bias in this study. The evidence that CHMO is effective for pressure ulcer is encouraging, but due to several caveats, not conclusive. Therefore, more rigorous studies seem warranted.

Non-interventional study to investigate the efficacy and safety of Tegaderm™ Matrix in the treatment of patients with therapy-refractory chronic wounds

BACKGROUND

Despite a variety of therapeutic approaches, many patients with chronic wounds remain refractory to treatment. Products such as Tegaderm™ Matrix were developed especially for such patients to alter the wound environment and reactivate the stagnant wound healing process.

PATIENTS AND METHODS

In this prospective post-authorization observational product study, a total of 314 patients with therapy-refractory chronic wounds of various origins were evaluated. Beside to the wound area reduction and healing rate, the occurrence of adverse events was documented.

RESULTS

On average the wounds were 10 months old. The average wound size was 17.3 cm(2) (median 6.3 cm(2)) at the initial visit. In the course of treatment the wound size decreased to 13.0 cm(2) (median 3.5 cm(2)) and was finally reduced to 9.3 cm(2) (median 0.9 cm(2)) at end of the study. Taking the criteria of the European Wound Management Association for improving the quality of clinical studies into consideration, a wound size reduction of at least 50% is the parameter for successful treatment of chronic wounds. This study demonstrated a wound size reduction of at least 50% for 72.9% of the patients with therapy-refractory chronic wounds when treated with Tegaderm™ Matrix. The safety profile was evaluated; only 4.7% of the patients experienced a treatment-related adverse event such as a burning sensation.

CONCLUSIONS

The results of the study demonstrate that Tegaderm™ Matrix along with treatment of underlying causes is a well tolerated wound dressing promoting wound size reduction up to healing for the majority of patients with previously therapy-refractory chronic wounds.