Wundheilungsstörungen im Kontext - Epidemiologie und Pathophysiologie

In Germany, between 400,000 and 800,000 people currently suffer from a chronic wound requiring treatment. The majority are based on a vascular genesis. In addition to revascularization, knowledge of the wound treatment as well as the pathophysiology are necessry for a vascular surgeon. In a review article the complex physiological wound healing mechanisms of the vascular-linked pathomechanisms are discussed as well as factors which lead to chronification of wounds. In the inflammation phase after injury to the skin integument, the coagulation cascade is initiated and thrombocytes are activated. Thrombocytes secreting growth factors, macrophages and granulocytes ensure elimination of the cell detritus and repel microorganisms. Proteases support debridement and cytokines and monocytes stimulate angiogenesis and promote fibroblast proliferation. In this proliferative phase, the granulation tissue required for wound healing is generated. The last phase of wound healing (reparation phase) involves re-epithelialization of the wound, keratinocyte regeneration and as a result, the transformation of collagen III into collagen I for formation of scar tissue. In addition to an untreated primary disease, disturbing factors of wound healing are wound infections, the presence of hypoxia, necrosis, untreated metabolic disturbances and also nutrient deficiency. Topically applied autologous stem cells provide approaches to positively influence the regeneration process at the cellular level.