Though the data are still sparse, the high reported rates of limb preservation imply that peripheral revascularization techniques can play a major role in the treatment of chronic critical limb ischemia (CLI). Therefore, these techniques are recommended without exception by the current guidelines.
ZusammenfassungDas Erysipel ist eine bakterielle Weichgewebeinfektion, die durch β-hämolysierende Streptokokken verursacht wird und sich entlang der Lymphspalten der Haut nach proximal ausbreitet. Die Eintrittspforten der Erreger können kleinere Verletzungen oder auch chronische Wunden sein. Die Diagnose Erysipel wird klinisch durch die sich ausbreitende Rötung und Überwärmung der Haut, den reduzierten Allgemeinzustand mit Fieber und Schüttelfrost sowie mittels serologischer Entzündungsparameter gestellt und muss von zahlreichen Differenzialdiagnosen abgegrenzt werden. Die systemische Therapie erfolgt meist mit Penicillin. In der Lokaltherapie ist der Stellenwert der Maßnahmen wie Kompressionstherapie oder Kühlung derzeit noch umstritten. Insbesondere für die Rezidivprophylaxe sind die langfristige Therapie des Lymphödems sowie die konsequente Vermeidung und Therapie von Eintrittspforten essenziell.
Compression therapy is the basis for successful treatment in most patients with venous leg ulcers. Concerning compression therapy, the initial phase of decongestion and the following phase of maintenance should be differentiated. While in the maintenance phase (ulcer) stocking systems are now frequently recommended, in the decongestion phase compression bandages are mostly still used, which however are often inappropriately applied. In German-speaking countries, compression therapy with short-stretch bandages has a long tradition. However, their correct application requires good training and monitoring, which is often lacking in daily practice. Less error-prone treatment alternatives are multicomponent systems, some of which have an optical marker for the control of the correct subbandage pressure. In another new type of compression system, which is called adaptive or wrap bandages, the compression pressure can be adjusted using a Velcro fastener. Accompanying intermittent pneumatic compression therapy can also be used in the decongestion phase. Thus, there are now several different treatment options that can be used for the decongestion phase in patients with venous leg ulcers. Often bandages with short-stretch materials are very prone to errors and should in most cases be replaced by other compression systems today. The patient's preference, need, and capability should be considered when selecting the appropriate system for the individual patient.
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