Pathogenese des chronisch-venösen Ulcus cruris

Zusammenfassung

Die physiologische Wundheilung umfasst mehrere Phasen: Entzündungphase mit initialer Blutstillung, Bildung eines Granulationsgewebes, Matrixsynthese und Remodellierung des Ersatzgewebes. In den westlichen Industrienationen ist insbesondere die chronisch-venöse Insuffizienz für Wundheilungsstörungen im Bereich der unteren Extremität verantwortlich. Chronisch-venöse Ulzerationen durchlaufen nicht den physiologischen Wundheilungsablauf, sondern persistieren mit geringer Heilungstendenz in der inflammatorischen Phase.

Das molekulare Verständnis der verzögerten Wundheilung im Rahmen der chronisch-venösen Insuffizienz ist entscheidend für die Entwicklung neuer Therapiestrategien. Aktuell stellen plastisch-rekonstruktive Maßnahmen, die Kompressionstherapie und bei therapierefraktärem Ulcus cruris venosum auch die chirurgische Abtragung des liposklerotischen, periulzerösen Gewebes gängige therapeutische Alternativen dar, um das chronisch aggressive Mikromilieu in ein für die Heilung förderliches umzustellen.

Summary

Physiologic wound healing comprises different phases: inflammation, formation of granulation tissue, extracellular matrix synthesis, and remodelling of the restoration tissue. Chronic venous insufficiency is the main cause for impaired wound healing of lower leg. In industrialised countries chronic venous leg ulcers fail to progress through the normal pattern of wound repair but remain in a chronic inflammatory state with little tendency of healing.

The molecular understanding of the delayed wound healing process in chronic venous insufficiency is crucial for the development of novel therapeutic options. Currently, reconstructive surgery compression therapy aimed at the reduction of the increased hydrostatic pressure in the lower leg and in therapeutically resistant cases shave therapy with elimination of the liposclerotic tissue around the ulcer are recommended to change the prooxidative microenenvironment to a more favourable one enhancing tissue repair.

Résumé

La cicatrisation physiologique d´une plaie se déroule en plusieurs phases, la phase exsudative avec l´hémostase, la phase proliférative avec le développement d´un tissu cicatriciel. Dans les pays industriels occidentaux c´est surtout l´insuffisance veineuse chronique, qui est responsable pour des problèmes de cicatrisation au niveau des membres inférieurs. Les ulcérations chroniques veineuses ne s´évoluent pas selon le déroulement physiologique de la cicatrisation, mais persistent avec peu de tendance de guérison dans la phase inflammatoire.

La compréhension des processus au niveau moléculaire de la cicatrisation retardée est décisive pour le développement de nouvelles stratégies thérapeutiques. En ce moment c´est la chirurgie plastique et reconstructive et la thérapie de compression et pour l´ulcère chronique veineux qui est réfractaire à la thérapie c´est l´ablation chirurgicale du tissu sclérotique peri ulcéreux, qui sont les alternatives thérapeutiques courantes pour changer le micromilieu chronique aggressif dans un qui est salutaire à la guérison.

Schlüsselwörter

Wundheilung - Ulcus cruris

Keywords

Wound healing - chronic venous limb ulcer

Mots clés

Cicatrisation - ulcère du pied

• Literatur

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