The outpatient wound clinic specialises in the diagnosis and treatment of poorly healing wounds.
In industrialised nations, more than two percent of all people, including around 1 to 1.5 million people in Germany alone, suffer from a poorly healing wound that is resistant to treatment. Patients sometimes complain of severe physical pain, restricted mobility, often also social isolation and serious restrictions in their quality of life.

Physiological wound healing can be divided into the following phases:

  • Inflammation (wound cleansing or exudative phase)

  • Proliferation (granulation phase, phase of new tissue formation)

  • Reparation (formation of epidermis over the wound bed)

Physiologically, these phases partly overlap or run in parallel. In poorly healing wounds, the inflammation phase often persists. A predominance of pro-inflammatory factors with a simultaneous lack of anti-inflammatory mediators disrupts the healing of chronic wounds. Further studies, which are being carried out in a multi-centre setting at the clinic here, among others, should help to clarify the pathogenesis of chronic wounds more precisely in the near future and thus lead to new treatment strategies.

A wound is considered resistant to therapy if there is no healing tendency within 3 months under optimal conservative therapy or if it has not healed within 12 months. Ulcers are poorly healing, sometimes infected wounds on the skin or mucous membranes that extend into the deep layers of the skin (corium), sometimes into the fatty tissue or onto the periosteum.
The causes of delayed wound healing are manifold. Insufficiency of the veins is the most common cause of chronic wound healing disorders on the lower leg. Other triggers include arterial occlusive disease (arteriosclerosis), wound healing disorders in diabetes mellitus, restricted mobility, after operations, radiotherapy or chemotherapy and vascular inflammation (vasculitis).

Interdisciplinary wound treatment means not only treating the wound, but also analysing the causes. Factors that cause poor wound healing must be considered and, if possible, eliminated and treated. These include metabolic diseases, genetic diseases of the coagulation system, connective tissue metabolism, adhesion molecules, but also rheumatological-inflammatory and arteriosclerotic vascular diseases. In addition, poorly healing wounds can occur in age-related syndromes (progeria, DNA double-strand break syndromes). Our phlebology consultation (vein consultation) uses non-invasive and non-stressful methods to gain important insights into diseases of the arteries and veins.
Close cooperation with other specialist disciplines such as the departments of internal medicine, radiology, neurology, orthopaedics and surgery as well as general practitioners is at the centre of our work. Specialised pain therapy can be offered for long-lasting, therapy-resistant pain.
Due to local therapy with various creams and ointments, which is often carried out over many years, allergic contact sensitisation occurs in 60-90% of patients.
One of the reasons for this is the impaired epidermal barrier function due to the pre-existing chronic inflammation. In particular, the care of neighbouring healthy skin with various preservative-containing ointments and creams often leads to allergies. If the wound edge is red and scaly, a contact allergy should therefore always be ruled out. This can be carried out in our allergy outpatient clinic in parallel with the diagnosis and treatment of the wounds.
Overall, there is close co-operation with other functional areas of dermatology, which work hand in hand in the diagnosis and treatment of poorly healing wounds.

After clarification and elimination of the causes in co-operation with other specialist disciplines, the treatment of the open leg takes centre stage:

 

  • Phase-appropriate therapy according to the principle of moist wound treatment

  • Instructions for the correct application of a wound dressing by doctors and nurses with specialised training

  • Compression therapy under supervision for patients with chronic venous disorders

  • Supporting measures such as physiotherapy and lymphatic drainage are offered in-house by our physiotherapist, Mr Jens Lütge

  • As part of therapy studies, we offer the latest therapy options such as treatment with growth factors

Our team consists of experienced nursing staff from the outpatient clinic and a team of doctors specially trained in the treatment of chronic wounds.
In co-operation with the day clinic and the ward, there is the possibility of curettage, vegative pressure therapy (V.A.G.), full and split skin coverage, plastic defect coverage and wound shaving, keratinocyte transplants. Combined treatment with plastic-reconstructive interventions on the venous system and the existing wound is often necessary (vein consultation, surgical procedures).

 

The Department of Dermatology and Allergology is significantly involved in the development of allogeneic stem cell therapy as a treatment option for non-healing chronic venous ulcers as part of the Cascade network within the 7th Framework Programme of the European Community.

The Department of Dermatology and Allergology has very good connections to the Board of the European Tissue Repair Society and the Wound Healing Society (USA). There is also a research focus in the field of wound healing and tissue regeneration in the context of regenerative medicine. This research focus is funded by the Landesstiftung Baden-Württemberg.