Internationale Klinische Empfehlungen zur Narbenbehandlung

U. E. Ziegler

doi:10.1055/s-2004-822830

Zentralblatt für Chirurgie, Table of Contents

Zentralbl Chir 2004; 129(4): 296-306
DOI: 10.1055/s-2004-822830

Originalarbeiten und Übersichten

Internationale Klinische Empfehlungen zur Narbenbehandlung [1]

International Clinical Recommendations on Scar ManagementU. E. Ziegler¹

¹Plastische Chirurgie und Handchirurgie, Chirurgische Universitätsklinik Würzburg

Abstract

Zusammenfassung

Viele Methoden zur Behandlung hypertropher Narben und Keloide haben sich bereits durch ihren intensiven Einsatz bewährt, aber wenige wurden durch prospektive Studien mit adäquaten Kontrollgruppen bestätigt. Eine Reihe von neuen Therapieformen zeigten in kleineren Studien gute Ergebnisse, doch wurden sie nicht in größer angelegten Studien mit langfristiger Nachbeobachtung erneut untersucht. Dieser Artikel eines internationalen Expertengremiums liefert eine qualitative Übersicht der vorliegenden klinischen Literatur, die mit Hilfe von Standardmethoden bewertet wird. Der Beitrag spricht evidenzbasierte Empfehlungen zur Prävention und Therapie von krankhaften Narbenbildungen aus und legt, wo die Studienlage unzureichend ist, einen Konsensus zur bestmöglichen Praxis dar. Die Empfehlungen konzentrieren sich auf die Behandlung von hypertrophen Narben und Keloiden und sind bei einem großen Spektrum von klinischen Bildern international anwendbar. Sie ermutigen zu einem vermehrt evidenzbasierten Ansatz in der Narbenbehandlung. Dieser Ansatz betont in der Behandlung vielfältiger krankhafter Narbenbildungen die vorrangige Rolle der Silikongel-Folien und der intraläsional injizierten Kortikosteroide. Die Verfasser schließen aus ihrer Analyse, dass es sich bei diesen beiden um die einzigen Therapieoptionen handelt, für die ausreichende Nachweise existieren, um daraus evidenzbasierte Empfehlungen abzuleiten. Eine Zahl anderer Behandlungsformen, die häufig eingesetzt werden, wurden von den Verfassern als Standardpraxis akzeptiert. Jedoch ist es sehr wünschenswert, dass viele solcher Standardverfahren und die neu aufkommenden Therapieformen in groß angelegten Studien mit langfristiger Nachbeobachtung geprüft werden, bevor sie schlüssig als Alternativen in der Narbenbehandlung empfohlen werden können.

Abstract

Many techniques for management of hypertrophic scars and keloids have been proven through extensive use, but few have been supported by prospective studies with adequate control groups. Several new therapies showed good results in small-scale trials, but these have not been repeated in larger trials with long-term follow-up. This article reports a qualitative overview of the available clinical literature by an international panel of experts using standard methods of appraisal. The article provides evidence- based recommendations on prevention and treatment of abnormal scarring and, where studies are insufficient, consensus on best practice. The recommendations focus on the management of hypertrophic scars and keloids, and are internationally applicable in a range of clinical situations. These recommendations support a move to a more evidence-based approach in scar management. This approach highlights a primary role for silicon gel sheeting and intralesional corticosteroids in the management of a wide variety of abnormal scars. The authors concluded that these are the only treatments for which sufficient evidence exists to make evidence-based recommendations. A number of other therapies that are in common use have achieved acceptance by the authors as standard practice. However, it is highly desirable that many standard practice and new emerging therapies undergo large-scale studies with long-term follow-up before being recommended conclusively as alternative therapies for scar management.

Schlüsselwörter

Narbentherapie - Keloid - hypertrophe Narben

Key words

Scar therapy - keloid - hypertrophic scar

Full Text

References

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1 Dieser Artikel bietet ein Konsensus zur bestmöglichen Praxis durch einen internationalen Expertenkreis mit umfassender Erfahrung an der Therapie von Narben. Er gibt einen qualitativen Überblick über mehr als 300 Publikationen, bei der die Bewertung anhand von Standardmethoden erfolgt, und legt da, wo die Studienlage unzureichend ist.

1 Die Erstveröffentlichung erfolgte in Plastic and Reconstructive Surgery, (8/2002),Vol. 110, No. 2: 560-571. Um eine Verbreitung zu erreichen, werden in den einzelnen Ländern, in verschiedenen Sprachen, die Empfehlungen in ausgesuchten Fachzeitschriften veröffentlicht. Das Exklusivrecht für die Bundesrepublik Deutschland liegt beim Verfasser dieses Artikels.

1 Ulrich E. Ziegler, Thomas A. Mustoe, M. D., Rodney D. Cooter, M. D., Michael H. Gold, M. D., F. D. Richard Hobbs, F. R. C. G. P., Albert-Adrien Ramelet, M. D., Peter G. Shakespeare, M. D., Maurizio Stella, M. D., Luc Téot, M. D., Fiona M. Wood, M. D.
für das „International Advisory Panel on Scar Management”

1 Würzburg/Deutschland, Chicago, Ill., Nashville, Tenn./ USA, Adelaide/ Südaustralien und Perth/ Westaustralien, Birmingham und Salisbury/Großbritannien, Lausanne/Schweiz, Turin/Italien und Montpellier/Frankreich

1 Plastische Chirurgie und Handchirurgie Chirurgische Universitätsklinik, Northwestern University School of Medicine, Royal Adelaide Hospital and The Queen Elizabeth Hospital, Gold Skin Care Centre, University of Birmingham, Laing Burn Research Laboratories, Salisbury District Hospital, Burn Centre, CTO, Burns Unit University Hospital Lapeyronie, Burns Unit and Royal Perth Hospital and Princess Margaret children's Hospitals.

Oberarzt Dr. med. Ulrich E. Ziegler

Plastische Chirurgie und Handchirurgie, Chirurgische Universitätsklinik

Oberdürrbacherstr. 6

97080 Würzburg

Phone: +49/9 31 20 13 70 32

Fax: +49/9 31 20 13 70 39

Email: ulrich.ziegler@mail.uni-wuerzburg.de