Zusammenfassung
In der modernen Wissenschaft vollziehen sich die Wechsel von wissenschaftlichen Paradigmen
stetig und oft unbemerkt. Neue Therapieverfahren, deren Effekte mit der bis dahin
gültigen Lehrmeinung nicht vereinbar sind, lösen zunächst widersprüchliche Diskussionen
aus und führen dann je nach Erkenntnislage zu neuen Lehrmeinungen. Die kontinuierliche
computergestützte lokale Unterdrucktherapie (Vakuumtherapie, V.A.C.®, topische negative
Druckbehandlung) hat seit ihrer Einführung zu anfangs unerwarteten und beeindruckenden
klinischen Ergebnissen geführt, die zu einem erkennbaren Wandel verschiedener therapeutischer
Konzepte in der rekonstruktiven Chirurgie geführt haben. Anhand einer Auswahl wichtiger
klinischer Beispiele aus der rekonstruktiven Chirurgie wird aufgrund einer aktuellen
Literaturrecherche der Versuch unternommen, erkennbare Paradigmenwechsel in den Behandlungsalgorithmen
aufzuzeigen, die sich durch die Einführung der Vakuumtherapie in den letzten Jahren
abgezeichnet haben.
Abstract
In modern science the changes of scientific paradigm occur constantly and often unnoticed.
Effects of new therapy procedures that are not compatible with the prevailing doctrines
first lead to contradictory discussions and may then lead to new doctrines depending
upon the general perception. Continuous computer-assisted local negative pressure
therapy (vacuum assisted closure therapy/V.A.C.®, topical negative pressure treatment)
has led to unexpected and impressing clinical results since its introduction. This
has provoked a recognizable change of different therapeutic concepts in reconstructive
surgery. Based on a selection of important clinical examples from reconstructive surgery
following a current literature research the attempt is undertaken to point out recognizable
changes of paradigms within the treatment algorithms that can be discerned after the
the introduction of vacuum therapy in recent years.
Schlüsselwörter
Paradigmenwechsel - rekonstruktive Chirurgie - Vakuumtherapie
Key words
changing paradigms - reconstructive surgery - vacuum therapy
Literatur
- 1
Adamkova M, Tymonova J, Zamecnikova I, Kadlcik M, Klosova H.
First experience with the use of vacuum assisted closure in the treatment of skin
defects at the burn center.
Acta Chir Plast.
2005;
47
24-27
- 2
Agarwal J P, Ogilvie M, Wu L C, Lohman R F, Gottlieb L J, Franczyk M, Song D H.
Vacuum-assisted closure for sternal wounds: a first-line therapeutic management approach.
Plast Reconstr Surg.
2005;
116
1035-1040
- 3
Argenta L C, Morykwas M J.
Vacuum-assisted closure: a new method for wound control and treatment: clinical experience.
Ann Plast Surg.
1997;
38
563-576
- 4
Armstrong D G, Lavery L A.
Negative pressure wound therapy after partial diabetic foot amputation: a multicentre,
randomised controlled trial.
Lancet.
2005;
366
1704-1710
- 5
Avery C, Pereira J, Moody A, Gargiulo M, Whitworth I.
Negative pressure wound dressing of the radial forearm donor site.
Int J Oral Maxillofac Surg.
2000;
29
198-200
- 6
Blackburn J H, Boemi L, Hall W W, Jeffords K, Hauck R M, Banducci D R, Graham W P.
Negative-pressure dressings as a bolster for skin grafts.
Ann Plast Surg.
1998;
40
453-457
- 7
Clubley L, Harper L.
Using negative pressure therapy for healing of a sternal wound.
Nurs Times.
2005;
101
44-46
- 8
Cowan K N, Teague L, Sue S C, Mahoney J L.
Vacuum-assisted wound closure of deep sternal infections in high-risk patients after
cardiac surgery.
Ann Thorac Surg.
2005;
80
2205-2212
- 9
DeFranzo A J, Argenta L C, Marks M W, Molnar J A, David L R, Webb L X, Ward W G, Teasdall R G.
The use of vacuum-assisted closure therapy for the treatment of lower-extremity wounds
with exposed bone.
Plast Reconstr Surg.
2001;
108
1184-1191
- 10
Domkowski P W, Smith M L, Gonyon D L, Drye C, Wooten M K, Levin L S, Wolfe W G.
Evaluation of vacuum-assisted closure in the treatment of poststernotomy mediastinitis.
J Thorac Cardiovasc Surg.
2003;
126
386-390
- 11
Doss M, Martens S, Wood J P, Wolff J D, Baier C, Moritz A.
Vacuum-assisted suction drainage versus conventional treatment in the management of
poststernotomy osteomyelitis.
Eur J Cardiothorac Surg.
2002;
22
934-938
- 12
Elwood E T, Bolitho D G.
Negative-pressure dressings in the treatment of hidradenitis suppurativa.
Ann Plast Surg.
2001;
46
49-51
- 13
Fleck T, Moidl R, Giovanoli P, Wolner E, Grabenwoger M.
[Early treatment of sternal wound infections with vacuum assisted closure therapy
reduces involvement of the mediastinum and further diminishes the need of plastic
reconstructive surgery].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 35-S 37
- 14
Fleischmann W, Lang E, Kinzl L.
[Vacuum assisted wound closure after dermatofasciotomy of the lower extremity].
Unfallchirurg.
1996;
99
283-287
- 15
Fleischmann W, Lang E, Russ M.
[Treatment of infection by vacuum sealing].
Unfallchirurg.
1997;
100
301-304
- 16
Fleischmann W, Strecker W, Bombelli M, Kinzl L.
[Vacuum sealing as treatment of soft tissue damage in open fractures].
Unfallchirurg.
1993;
96
488-492
- 17
Ford S J, Rathinam S, King J E, Vaughan R.
Tuberculous osteomyelitis of the sternum: successful management with debridement and
vacuum assisted closure.
Eur J Cardiothorac Surg.
2005;
28
645-647
- 18
Gaarder C, Naess P A, Schwab C W, Bjornbeth B A, Buanes T, Pillgram-Larsen J.
[Vacuum pack technique - a good method for temporal abdominal closure].
Tidsskr Nor Laegeforen.
2004;
124
2760-2762
- 19
Giovannini U M, Settembrini F, Colonna M R, Teot L, Giofre C, Amadeo G, Strano A,
Stagno D'Alcontres F.
Topical negative therapy and vacuum assisted closure. New strategies and devices in
surgical reconstruction.
Minerva Chir.
2005;
60
191-194
- 20
Harlan J W.
Treatment of open sternal wounds with the vacuum-assisted closure system: a safe,
reliable method.
Plast Reconstr Surg.
2002;
109
710-712
- 21
Haslik W, Kamolz L P, Andel H, Meissl G, Frey M.
[The use of subatmospheric pressure to prevent burn wound progression: first experiences
in burn wound treatment].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 62-S 63
- 22
Heller G, Savolainen H, Widmer M K, Makaloski V, Menth M, Schmidli J.
[Vacuum-assisted therapy in vascular surgery].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 66-S 70
- 23
Horch R E, Schipper J H, Maier W, Laszig R.
Plastisch rekonstruktive Chirurgie freier mikrovaskulär anastomisierter und gestielter
Lappenkonstrukte mit Hilfe der V.A.C.®-Therapie.
Thieme Verlag, Stuttgart, New York.
2003;
28
125
- 24
Horch R E.
Grundlagen und Ergebnisse der Vakuumtherapie (V.A.C.®) in der rekonstruktiven Chirurgie.
Zentralbl Chir.
2004;
129
2-5
- 25
Horch R E.
[Treatment of decubitus ulcers in the geriatric patient].
MMW Fortschr Med.
2003;
145
42-46
- 26
Horch R E, Andree C, Walgenbach K, Voigt M, Bannasch H, GB S.
Vacuum assisted closure for coverage of extensive soft tissue defects and skin graft
fixation.
J Wound Healing ZfW.
2000;
5
17-19
- 27
Horch R E, Bach A, Loos B, Kopp J.
Sicherheitsaspekte und Indikationen der V.A.C.® Therapie in der Plastischen Chirurgie.
European Surgery - ActaChir Aust.
2003;
35
5-7
- 28
Horch R E, Bach A, Loos B, Schipper J, Kopp J.
Prefabrication of threedimensional newly generated compound flaps in Plastic Surgery
with the use of V.A.C.®.
European Surgery - Acta Chir Aust.
2003;
35
18-20
- 29
Horch R E, Bannasch H, Andree C, Kopp J, Stark G.
Single cell suspensions of cultured human keratinocytes in fibrin glue reconstitute
the epidermis.
Cell Transplantation.
1998;
7
309-317
- 30
Horch R E, Gerngroß H, Lang W, Mauckner P, Nord D, Peter R U, Vogt P M, Wetzel-Roth W,
Willy C.
Indications and safety aspects of vacuum therapy (V.A.C.®).
MMW Fortschr Med.
2005;
147
1-5
- 31
Horch R E, Jeschke M, Loos B, Lang W, Horbach T.
Ulcus cruris - Chirurgische Verfahrenswahl, Debridement, Shaving, Fasziektomie, Transplantation.
MedReport.
2003;
27
8-13
- 32 Horch R E, Kopp J, Bach A, Strnad V, Grabenbauer G, Sauer R. Vakuumtherapie integriert
in ein perioperatives Strahlenkonzept bei malignen Weichteiltumoren. In: Willy C (ed).
Die Vakuumtherapie. Williy Eigenverlag, Ulm 2005; 191-196
- 33
Horch R E, Krönung G B.
Infektprophylaxe bei Teflonprothesen für den Dialysezugang - Erfahrungen mit einem
resorbierbaren Kollagen-Antibiotikum-Verbundsystem.
VASA.
1989;
18
30-34
- 34
Horch R E, Stark G.
Prosthetic vascular graft infection - defect covering with delayed vertical rectus
abdominis muscular flap.
VASA.
1994;
23
52-56
- 35
Immer F F, Durrer M, Muhlemann K S, Erni D, Gahl B, Carrel T P.
Deep sternal wound infection after cardiac surgery: modality of treatment and outcome.
Ann Thorac Surg.
2005;
80
957-961
- 36
Jeschke M, Horch R.
Akute und chronische Wunden - Kombinierte Behandlung aus einer Kollagenmatrix, Fibrinkleber
und Vakuum-Verbänden.
Plast Chir.
2003;
3
127-131
- 37
Kall S, Kilpadi D, Reimers K, Choi C Y, Jahn S, Vogt P M.
[Influence of foam- and tubing material of the vacuum assisted closure device (V.A.C.®)
on the concentration of transforming growth factor Beta 1 in wound fluid].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 113-S 115
- 38
Kamolz L P, Andel H, Haslik W, Winter W, Meissl G, Frey M.
Use of subatmospheric pressure therapy to prevent burn wound progression in human:
first experiences.
Burns.
2004;
30
253-258
- 39
Kelm J, Anagnostakos K, Schmitt E.
[Closed subfascial V.A.C.®-therapy in periprosthetic hip infections].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 49-S 52
- 40
Kneser U, Bach A D, Polykandriotis E, Kopp J, Horch R E.
Delayed reverse sural flap for staged reconstruction of the foot and lower leg.
Plast Reconstr Surg.
2005;
116
1910-1917
- 41
Kopp J.
Lokaler negativer Druck steigert die Wachstumsfaktor-Expression in diabetischer neuropathischen
Fußulcera.
Plastische Chirurgie.
2003;
3 (Suppl 1)
92
- 42
Kopp J, Bach A, Loos B, Polykandriotis E, Kneser U, Seyhan H, Ohnolz J, Horch R E.
[Use of vacuum therapy during defect coverage of the upper extremity with microsurgically
grafted arterialized venous flaps].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 82-S 84
- 43
Kopp J, Jeschke M G, Bach A D, Kneser U, Horch R E.
Applied tissue engineering in the closure of severe burns and chronic wounds using
cultured human autologous keratinocytes in a natural fibrin matrix.
Cell Tissue Bank.
2004;
5
89-96
- 44
Kopp J, Kneser U, Bach A D, Horch R E.
Buried chip skin grafting in neuropathic diabetic foot ulcers following vacuum-assisted
wound bed preparation: enhancing a classic surgical tool with novel technologies.
Int J Low Extrem Wounds.
2004;
3
168-171
- 45
Kopp J, Strnad V, Bach A D, Sauer R, Horch R E.
Vacuum application increases therapeutic safety and allows intensified local radiation
treatment of malignant soft-tissue tumors.
Strahlenther Onkol.
2005;
181
124-130
- 46
Kutschka I, Frauendorfer P, Harringer W.
[Vacuum assisted closure therapy improves early postoperative lung function in patients
with large sternal wounds].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 33-S 34
- 47
Labler L, Keel M, Trentz O.
[New application of V.A.C.® (vacuum assisted closure) in the abdominal cavity in case
of open abdomen therapy].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 14-S 19
- 48
Loos B, Kopp J, Bach A, Kneser U, Polykandriotis E, Hohenberger W, Horch R.
Integration exponierter alloplastischer Netze in bestrahlten Problemwunden durch lokale
Vakuumapplikation.
Zentralbl Chir.
2004;
129
5-8
- 49
Loos B, Kopp J, Bach A, Kneser U, Polykandriotis E, Hohenberger W, Horch R E.
[Salvage of exposed alloplastic materials in irradiated wounds - a case report].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 133-S 136
- 50
Miller P R, Meredith J W, Johnson J C, Chang M C.
Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned
ventral hernia rate is substantially reduced.
Ann Surg.
2004;
239
608-614
- 51
Moch D, Fleischmann W, Westhauser A.
[Instillation vacuum sealing - report of initial experiences].
Langenbecks Arch Chir Suppl Kongressbd.
1998;
115
1197-1199
- 52
Molnar J A.
Applications of negative pressure wound therapy to thermal injury.
Ostomy Wound Manage.
2004;
50 (Suppl 4 A)
17-19
- 53
Molnar J A, DeFranzo A J, Hadaegh A, Morykwas M J, Shen P, Argenta L C.
Acceleration of Integra incorporation in complex tissue defects with subatmospheric
pressure.
Plast Reconstr Surg.
2004;
113
1339-1346
- 54
Morykwas M J, Argenta L C, Shelton-Brown E I, McGuirt W.
Vacuum-assisted closure: a new method for wound control and treatment: animal studies
and basic foundation.
Ann Plast Surg.
1997;
38
553-562
- 55
Morykwas M J, Kennedy A, Argenta J P, Argenta L C.
Use of subatmospheric pressure to prevent doxorubicin extravasation ulcers in a swine
model.
J Surg Oncol.
1999;
72
14-17
- 56
Pinocy J, Albes J M, Wicke C, Ruck P, Ziemer G.
Treatment of periprosthetic soft tissue infection of the groin following vascular
surgical procedures by means of a polyvinyl alcohol-vacuum sponge system.
Wound Repair Regen.
2003;
11
104-109
- 57
Rexer M, Ditterich D, Rupprecht H.
[V.A.C.®-therapy in abdominal surgery - experiences, limits and indications].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 27-S 32
- 58
Rozeboom A L, Havekes B, Steenvoorde P, Arbous M S, Elzo Kraemer C V, de Velde C J
van.
[The abdominal compartment syndrome].
Ned Tijdschr Geneeskd.
2005;
149
1309-1313
- 59
Scherer L A, Shiver S, Chang M, Meredith J W, Owings J T.
The vacuum assisted closure device: a method of securing skin grafts and improving
graft survival.
Arch Surg.
2002;
137
930-933
- 60
Schipper J, Ridder G, Maier W, Kopp J, Bach A, Laszig R, Horch R.
Präfabrikation dreidimensionaler Lappenkonstrukte mittels Vakuumtherapie.
ZfW J Wound Healing.
2003;
8
93-99
- 61
Schipper J, Ridder G J, Maier W, Horch R E.
[The preconditioning and prelamination of pedicled and free microvascular anastomised
flaps with the technique of vacuum assisted closure].
Laryngorhinootologie.
2003;
82
421-427
- 62
Scholl L, Chang E, Reitz B, Chang J.
Sternal osteomyelitis: use of vacuum-assisted closure device as an adjunct to definitive
closure with sternectomy and muscle flap reconstruction.
J Card Surg.
2004;
19
453-461
- 63
Scott B G, Feanny M A, Hirshberg A.
Early definitive closure of the open abdomen: a quiet revolution.
Scand J Surg.
2005;
94
9-14
- 64
Song D H, Wu L C, Lohman R F, Gottlieb L J, Franczyk M.
Vacuum assisted closure for the treatment of sternal wounds: the bridge between debridement
and definitive closure.
Plast Reconstr Surg.
2003;
111
92-97
- 65
Steiert A E, Partenheimer A, Schreiber T, Muehlberger T, Krettek C, Lahoda L U, Vogt P M.
[The V.A.C.® system (vacuum assisted closure) as bridging between primary osteosynthesis
in conjunction with functional reconstructed of soft tissue - open fractures type
2 and type 3].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 98-S 100
- 66
Stone P A, Hass S M, Flaherty S K, DeLuca J A, Lucente F C, Kusminsky R E.
Vacuum-assisted fascial closure for patients with abdominal trauma.
J Trauma.
2004;
57
1082-1086
- 67
Tang A T.
Vacuum-assisted suction drainage of sternotomy infection: a new paradigm?.
Eur J Cardiothorac Surg.
2003;
23
649-650
- 68
Tautenhahn J, Pross M, Kuhn R, Eder F, Gebauer T, Burger T, Lippert H.
[The use of V.A.C.®-system in wound management for borderline indications].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 12-S 13
- 69
Trautvetter R, Bauer K.
[Ulcus shaving and V.A.C.® therapy].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 38-S 39
- 70
Vogt P M, Kall S, Boorboor P, Lahoda L U.
[Several aspects of foam materials and their possible interactions with the wound
surface in the vacuum therapy].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 92-S 94
- 71
Gossler C M, Horch R E.
Rapid aggressive soft-tissue necrosis after beetle bite can be treated by radical
necrectomy and vacuum suction-assisted closure.
J Cutan Med Surg.
2000;
4
219-222
- 72
Lubken F, Thun-Hohenstein H, Weymouth M, Kossmann T, Gerngross H, Willy C.
[Pressure conditions under VVS-foams - an experimental in-vitro- and in-vivo-analysis].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 95-S 97
- 73
Wanner M B, Schwarzl F, Strub B, Zaech G A, Pierer G.
Vacuum-assisted wound closure for cheaper and more comfortable healing of pressure
sores: a prospective study.
Scand J Plast Reconstr Surg Hand Surg.
2003;
37
28-33
- 74
Wild T, Stremitzer S, Budzanowski A, Rinder H, Tamandl D, Zeisel C, Holzenbein T,
Sautner T.
[“Abdominal dressing” - a new method of treatment for open abdomen following secondary
peritonitis].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 20-S 23
- 75
Wild T, Wetzel-Roth W, Zoch G.
Consensus of the German and Austrian Societies for Wound Healing and Wound Management
on vacuum closure and the V.A.C.® treatment unit.
Zentralbl Chir.
2004;
129 (Suppl 1)
S 7-S 11
- 76 Willy C. Die Vakuumtherapie. Willy Eigenverlag, Ulm 2005
- 77
Willy C, Gerngross H.
[Scientific background of the vacuum closure - an abstract].
Zentralbl Chir.
2004;
129 (Suppl 1)
S 6
Univ.-Prof. Dr. med. R. E. Horch
Abteilung für Plastische und Handchirurgie · Universitätsklinikum Erlangen · Friedrich-Alexander-Universität
Erlangen-Nürnberg
Krankenhausstraße 12
91054 Erlangen
Phone: 0 91 31/85/3 32 77
Email: raymund.horch@chir.imed.uni-erlangen.de
