Clinical Treatment Clinical Treatment

作者:Rong Xiang Xu 出版社:KARGER 发行日期:In 2004

(1) Treatment for first-degree burns: The clinical signs of first-degree burns include skin redness, slight swelling and pain. Immediate application of MEBO may relieve the pain. The erythema gradually diminishes as MEBO is warmed in situ and absorbed through the skin. At 12 h postburn, the skin may return to normal. For burns with edema, the epidermis is partially destroyed, the pains may be relieved more slowly and the wounds heal in 2~4 days when the superficial stratum corneum exfoliates.

(2) Treatment for superficial II-degree burn: According to the pathogenic process of superficial second-degree burns, the treatment can be carried out in two stages.

First stage: Treatment in the early stage ---- the period from emergency treatment postburn to the end of shock period (within 3~4 days after injury). The clinical signs in this stage include pain, edema, blisters, and a great amount of blood plasma exudated from the site where blister skin exfoliates. According to the principle of BRT with MEBT/MEBO, apply MEBO directly all over the wound, puncture the blister (if present) on the lower part to discharge liquid. Do not remove the blister skin, directly apply MEBO on the blister skin 3~4 times daily. With the application of MEBO, a layer of thin soft membrane forms upon the wound free of blister skin, the membrane still allows the exudates to ooze through, and then it gradually thickens. Do not remove the soft membrane, since it can substitute the skin role of to fulfilling breathing and protection. Continue MEBO application directed by BRT..

Second stage: It is the wound-repairing period when the shock stage ends and the residual viable epidermis tissue begins to regenerate and recover, usually lasting 3~4 days. In this period, the basal cells in epidermis recover to form a granular layer and thus promote wound healing. In clinical treatment of BRT with MEBT/MEBO, after the edema period, the blister skin looses and exfoliates, and the thin soft membrane formed on the wounds also looses and exfoliates. Simply cleaning away the blister skin and soft membrane is first desired, then continue the application of MEBO to protect the regenerated wounds till healing. During the whole treatment, neither pains nor further injury to wounds is allowed. The correct application method helps the wounds heal without causing any infection, pain, scar formation or hyperpigmentation. Generally, superficial second-degree wounds treated with BRT with MEBT/MEBO heal within 6~8 days and the skin recovers completely to its normal physiological status within 3 months.

(3) Treatment for Deep Second-degree Burns:
According to pathological and clinical manifestations, deep second-degree burns can be divided into injury on the dermal papillary layer and injury on the reticular layer, or simply referred to as deep second-degree superficial (DIIS) and deep second-degree deep (DIID).

① DIIS: Clinical signs include wound pain, extensive blisters, wound without blister skin becoming red and white, the superficial dermal tissue is necrotic and turns white, the surviving deep dermis tissue is red, while under pressure it turns white and soon returns to red after release of pressure (DIID burns wounds respond more slowly). The exudates of the wounds are only less than those of superficial second-degree burns.

BRT with MEBT/MEBO treatment and clinical manifestation: It is a four-period process: firstly, treatment in the early stage (shock period), same as that for superficial second-degree burns; secondly, liquefaction and rejection period of necrotic dermal tissue (rejection period); thirdly, regeneration and recovery period, and, fourthly, rehabilitation period of skin physiological function after wound healing.

First period. The treatment of the first period is the same as that for superficial second-degree burns, emphasizing on wound protection. A thin layer of soft membrane may appear on the wound free of putrid skin or blistered skin. The next treatment period stsrts on day 4~5 postburn when the wound edema diminishes gradually.

Second period: Clean away the putrid skin, blistered skin or thin soft membrane in the same way as dealing with superficial second-degree burns. Continue the application of MEBO. Gradually, the necrotic layer of wound surface begins to liquefy from the superficies to the interior and produces white liquefied products floating over the wound surface. Usually at 3~4 h after application of MEBO, the wound is totally covered with whitish liquefied products, indicating that MEBO is consumed completely. The liquefaction products must be cleaned away before the renewal of MEBO. Another 3~4 h later, the renewed MEBO is consumed again when the liquefaction products float over the wound. Clean the liquefaction products, renew MEBO again and keep the clean-renew-clean process going until the necrotic tissues are entirely liquefied and discharged. This process generally occurs on 5~15 days postburn. Patients with large-area burns are urged to turn over during drug renewal.

Third period: After the second period treatment, the chestnut-like residual dermis tissues, millet-sized, are exposed on the basal layer of the wound. Continue MEBO with less thickness directed under BRT with MEBT/MEBO and renew every 4~5 h (every 6~8 h at night). Covered and protected by MEBO, the residual dermal tissue reconstructs and regenerates. Once dermis tissue regenerates to smooth skin, less irritation to the wound is allowed. Again reduce dosage and renewing times as long as the wound is not dry, but crust formation is forbidden, i.e., not only prevent wounds from being macerated by MEBO, but also avoid the wounds becoming dry and getting covered by a crust. Duly keep the normal skin around the wound clean. For large-area burn patients, do as in the second period by helping them turn over regularly on the basis of drug change intervals. The pressured parts of the body still need MEBO protection till the wounds heal. This period occurs on 15~20 days postburn.

Fourth period: Although the wound heals after the third stage, the functions of the newly healed skin still need to rehabilitate completely. The epidermis requires further physiological adjustment and metabolism; the sebaceous glands need compensatory metabolism; the excretory duct of the sweat gland is not yet clear; the functions of pigment cells are unable to meet the requirements of normal skin. Under these circumstances, MEBO is still necessary to be used as a skin-care oil for another 10~15 days. Or apply newly developed MEBO series products ---- MEBO Cleansing Cream to promote quicker recovery of skin function, or apply MEBO Itch Relieving Cream to stop itching.

② DIID: The clinical signs of deep second-degree deep burns are similar to those of deep second-degree superficial burns, except that DIID has more serious injuries and more serious response during liquefying period and therefore the reconstruction and regeneration of wounds become more complicated. The clinical treatment for deep second-degree deep burns also can be divided into four periods.

First period: Clinical signs ---- no extensive blisters, epidermis entirely destroyed and adherent to injured dermis, the wound free of putrid skin are no longer sensitive to pain, the wounds are white, with little exudate. Some of the wounds may be red alternating with white, but the color-changing responds to pressure is very slow. This period begins from the first day of burn through the 7th day postburn. During this period, simply apply MEBO to protect the wound.

Second period: From day 7 to day 20 postburn, clear away all adhering substances to expose necrotic dermis and apply BRT with MEBT/MEBO immediately. For small wound, simply use this treatment to liquefy and discharge the necrotic layer. For large burn, simple debridement should be used coordinately. The necrotic layer is so deep that the wound liquefying may be incomplete and cause lumps exfoliation of necrotic tissues, which need to be cut with surgical scissors and removed. Attention should be paid to keep a certain distance between the surviving viable tissue and the cutting. Any further damage to the surviving viable tissue such as bleeding (which may cause infection) should be absolutely avoided. Simple debridement can be adopted according to the condition of the wounds. When the necrotic layer is almost completely liquefied, clean away the liquefaction products in time to ensure that the non-smooth survival tissue is kept in a MEBO environment, but not in an environment filled with liquefaction products.

Third period: the period of reconstruction and regeneration of residual dermis tissue. As little residual dermis tissue is left and the dermis frame is fundamentally destroyed, correct BRT with MEBT/MEBO is quite vital in this period. The reconstruction of dermis tissue involves three parts: (a) the reconstruction of vascular tree; (b) the reconstruction of fibrous tissue dependent on vascular tree; (c) the regeneration of skin appendages, gland tissue, formation of excretory ducts and formation of skin tissue. Any careless injuries and pressure to the wound are forbidden. This period usually happens on day 20~28 postburn.

Fourth period: Aiming at helping the healed skin return to normal, the treatment in this period varies according to burns severity and skill in the treatment. The severe injuries to skin and the the factors affecting the skin during reconstruction make the newly healed skin quite different from normal skin in structure, appearance and function. So the rehabilitation is very important, including two aspects: “protective therapy for healed skin” and “functional exercise”. The former is accomplished by adjusting the structure of newly regeneration skin tissue with the application of MEBO Scar Lotion, by adjusting the function with MEBO Cleansing Cream, and by killing itch with MEBO Itching Reliever just after wounds heal.

(4) Treatment for third-degree burn: Third-degree burns are also an indication for BRT with MEBT/MEBO. As the epidermis and dermis of third-degree burn wound are totally destroyed, it is quite difficult to cure third-degree burns. The conventional medical science for burns is convinced that third-degree wounds cannot heal spontaneously, and the only solution is to use surgical skin grafting to close them. The clinical study and administration of BRT with MEBT/MEBO for curing third-degree burns wounds will be described in detail thereinafter. The following is just a brief description of the principle and method of this treatment..

Principle: Decompression of the deep tissues to relieve any pressure caused by the necrotic layer is of critical importance; protect the necrotic full-thickness skin; promote stem cells containing the skin information in subcutaneous tissue to regenerate and differentiate to form a skin island; culture the newly regeneration skin island while liquefying and discharging the necrotic dermis; promote skin island to spread and cover subcutaneous tissue to form new skin; and help third-degree burns wounds heal spontaneously. For third-degree wounds injured down to the muscle layer, excise most of the necrotic tissue by surgical operation, liquefy and discharge the rest of the necrotic layer with BRT with MEBT/MEBO, upon which culture granulation tissue, then plant skin cells till the wound closes and heals. For wounds with bone exposed, clean away the exposed outer soft tissue, drill holes on the bone surface with a bone drill at intervals of 0.5 ~1 cm, deep into medullary cavity of bone until bleeding. Apply MEBO to cover the wounds, and culture and support the growth of granulation tissue from the holes. When the granulation tissue spreads to cover the bone surface, skin grafting can be performed to close the wound, or the wound heals by migration of epithelial cells from wound edges.

The necrotic tissue of third-degree burns should be decompressed by cutting both horizontally and vertically at a 1 mm tooth distance and depth with a specially designed method: "plough saw blade". Then apply MEBO for protection and clean away the exfoliated or liquefied tissue.