Burns Regenerative Medicine and Therapy - part 9 ppsx

Experimental and Clinical Study on Burns Regenerative Medicine and Therapy with MEBT/MEBO 123and scarring of the wound.. Remark-ably, all of the deep partial-thickness burns wounds heale

Experimental and Clinical Study on Burns Regenerative Medicine and Therapy with MEBT/MEBO 123

and scarring of the wound While SD-Ag offers a degree of

prevention of wound infection, it does so at the expense of

wound regeneration and tissue repair because SD-Ag

inhibits these healthy recovery processes In an effort to

reduce the negative consequences of SD-Ag on tissue

regeneration, a modification of SD-Ag application was

developed whereby more frequent applications in an

occlusive manner strove to enhance the retention of tissue

moisture However, when SD-Ag cream has been used at

an increased frequency to avoid wound desiccation, many

disadvantages occur including toxicity, and other side

effects of using SD-Ag have been reported These include:

transient leukopenia; sulfonamide hypersensitivity and

kernicterus; argyria; local reactions of burning, itching

and skin rash; delayed separation of burn eschar and

regeneration of epithelial cells resulting in an increase of

scar formation; increase of bacterial resistance, etc The

pharmacological mechanism of MEBO to treat burns

wounds is completely different from SD-Ag MEBO can

promote the regeneration of survival viable skin tissue

and cells, then accelerate wound healing by keeping burns

wounds in a three-dimensional physiological moist

envi-ronment while simultaneously facilitating the

liquefac-tion and discharge of necrotic tissues without causing

fur-ther injury to viable tissue MEBO achieves its infection

control by means of enhancing the resistance of local

tis-sue to infection in the context of an environment which is

no longer conducive to bacterial colonization and

prolif-eration Rather than exercising a direct bactericidal

ac-tion, MEBO changes the biological characteristics and

decreases the toxicity and invasive activity of bacteria

Therefore, we selected SD-Ag as a control to clarify the

irrefutably superior therapeutic effects of MEBO as

com-pared to the industry’s standards

Effects of MEBO on Burns Wounds Management

According to the results of this trial, MEBO promotes

burns wound healing for each depth of wound

Remark-ably, all of the deep partial-thickness burns wounds

healed spontaneously after treatment with MEBO,

there-by requiring no skin grafting The rate of scar formation

was also markedly reduced compared to that of the

con-trol group Furthermore, in this trial, more than half of the

clinically diagnosed full-thickness burns wounds could be

healed spontaneously by treating with MEBO throughout

the treatment procedure without requiring any skin

graft-ing Treatment with MEBO provided burns wounds an

optimum physiological environment for regeneration and

repair Subsequent to application of MEBO, the wound

would heal spontaneously without further damage to

via-ble tissue Therefore, the rates of scar formation,

deformi-ty and disabilideformi-ty were all significantly decreased

com-pared to those of the control group Meanwhile, it was

found that in the MEBO treatment group, the incidence

rate of wound infection was significantly reduced com-pared to that in the control group, indicating that MEBO

is capable of preventing wound infection

Analgesic Effect and Alleviation of Pain of MEBO

It was determined in this trial that throughout the treatment and during dressing changes, the analgesic ef-fect and alleviation of pain in the MEBO treatment group was dramatically superior to that of the SD-Ag control group Unlike SD-Ag which required painful peeling away

of crusted and dried dressing from fragile tissue, treat-ment with MEBO neither aggravated the suffering and pain sensation during the treatment and changing of dressing, nor did it fail to offer a satisfactory analgesic effect The need for an analgesic agent was rare in the MEBO-treated group

Feasibility of MEBO for Treating Extensive Burns Patients

In this trial, 75 extensive burns patients with TBSA 150% were treated by BRT with MEBT/MEBO which resulted in a 100% success rate whereby all patients were completely healed when discharged from the hospital No toxicity, side effects and local or systemic allergic reac-tions were found In contrast, 2 of 31 extensive burns patients in the SD-Ag control group died and 18 of them were discharged with some residual wounds Meanwhile, almost half of the extensive burns patients in the SD-Ag control group who were failing treatment due to complica-tions of wound infection, bleeding, severe painful or delayed healing were switched into the MEBO group for ethical reasons, and, despite the relatively late access to MEBO, these patients achieved the same satisfactory results Therefore, it was concluded that treatment with MEBO throughout the clinical procedure for extensive burns patients was both feasible and safe In addition, it indicated that when the treatment with SD-Ag for exten-sive burns patients appeared to be unsatisfactory, switch-ing them into a MEBO protocol was reasonable and ap-propriate MEBO seemed to promote spontaneous heal-ing in the delayed-healheal-ing wound and was able to prevent

or decrease the need for skin grafting

In conclusion, a clinical display of MEBT/MEBO on

treating superficial and deep partial-thickness burns is shown in figure 50 In figure 51, the clinical procedure and display of MEBT/MEBO on treating facial full-thick-ness burns can be seen Figure 52 is a clinical graphic report of the granulation tissue regenerating from burned bone wounds treated with MEBT/MEBO Finally, a case report on the treatment of electrical injury with MEBT/ MEBO is shown in figure 53

Fig 50 a Burns wounds of superficial and deep partial thickness

degrees on the 1st day after injury b Applying MEBO directly,

treat-ment with MEBT c On the 3rd day after burn d On the 4th day after

injury, the wound of superficial partial thickness degree has started to

heal The wound of deep partial thickness degree has started to be

liquefied e On the 8th day after burn, the wound of superficial

tial thickness degree has healed completely The wound of deep

par-tial thickness degree has liquefied f On the 8th day after burn, the wound of deep partial thickness degree has liquefied g On the 12th

day after injury, most of the necrotic tissue has liquefied and dis-charged and the wound of deep partial thickness degree has started to

heal h On the 15th day after burn, most of the deep partial-thickness wounds is healed i On the 25th day after burn, the wound of deep

partial thickness degree has healed completely.

Experimental and Clinical Study on Burns Regenerative Medicine and Therapy with MEBT/MEBO 125

50

Fig 51 a Patient with facial burns after exposure to flame No pain

sensation, no exudate is observed b Histological examination of burns wounds showing full-thickness burns c Perform ‘skin

cultivat-ing and tension relievcultivat-ing’ with unique blade knife on burns wounds.

(For fig 51d–i see next page.)

Fig 51 d After cultivating, directly apply MEBO according to the

procedure of BRT e Day 2 postburn After cleaning the burns

wounds covered with MEBO, perform secondary ‘skin cultivating

and tension relieving’ according to MEBT f An excellent visual

example of the process of wound liquefaction on day 12 postburn.

g On day 18 postburn, the necrotic tissues were almost liquefied and

painlessly discharged while subcutaneous tissues were allowed to

regenerate new skin h On day 27 postburn, some burns wounds

healed with complete regeneration while other burn lesions were in

the process of healing i On day 50 postburn, burns wounds healed

and skin regenerated physiologically Note the symmetrical smile and the lack of scarring Full sensation has returned.

Experimental and Clinical Study on Burns Regenerative Medicine and Therapy with MEBT/MEBO 127

Fig 52 a Appearance of burned tibia of left leg b Removal of the

necrotic tissues at the surface of the bone c Removal of the necrotic

periosteum and outer cortex of tibia with scraper and bone chisel.

d Multiple holes drilled in the exposed tibia surface within a distance

of 1.0 cm, deep to viable marrow cavity with minor bleeding.

e Appearance of tibial surface after drilling f Subsequent to the

appli-cation of preserved soaked MEBO gauze to cover the wound, within

a few days, small granulating buds grew up through the drilled holes.

g With continuous treatment with BRT, the granulation tissue

devel-oped and spread to form a granulated wound Skin grafting was then performed to close the wound.

Fig 53 a This case involved sustained

elec-trical injury to wrist and forearm The pic-ture shows necrosis of anterior forearm muscles, radial and ulnar arteries The in-terosseous artery was viable The pressure pain point of the upper extremity was at the

elbow b After 55 days of treatment with

BRT, the necrotic tissues were liquefied and discharged while the wound on

anteri-or wrist at the site of defective muscles was filled with granulation tissue The wound is now healing from its margins by epithelial

migration c In another case, a 9-year-old

patient was injured by a 150,00-volt electric impulse on the head The injury went deep

into the skull d Two days after the burn,

the wound was cleaned and the necrotic tis-sue removed, then multiple holes were drilled into the skull followed by treatment with bone BRT MEBO was applied

direct-ly onto the wound e Fifteen days after

treatment with MEBT/MEBO, small gran-ulating buds grew up through the holes.

f Twenty-two days of treatment with BRT and MEBT/MEBO, granulating tissue developed and spread to form a

granulated wound and the new epithelial skin island appeared g Follow-up picture 2 years later The wound was

healed and the skull was completely covered.

Clinical Demonstrations of Burns Regenerative Medicine and Therapy (MEBT/MEBO) on Successful

Treatment of Extensive Burns

129

Fig 54 a TBSA 100%, deep second-degree 6%, third-degree 94%,

treatment with MEBT/MEBO b Prof Rong Xiang Xu evaluating and directing BRT treatment c Posterior view of wounds during treatment d The healing image (posterior) e The healing image

(an-terior).

Remarkably, rigorous sterile conditions are not

re-quired if burns regenerative medicine and therapy

(MEBT/MEBO) is used in the care of extensive burns

patients Basic equipment and general surgical conditions

typically suffice However, ambient room temperature of

32–36° C and careful, well-trained, intelligent nursing

care are required so that removing liquefied product in a

timely manner is accomplished In general, surgical

prin-ciples of systemic comprehensive treatment should be

fol-lowed Figure 54a–e shows Prof Rong Xiang Xu,

inven-tor of burns regenerative medicine and therapy (MEBT/

MEBO), as he assesses and directs the treatment for a

burns patient with deep burns of TBSA 100%

Extensive Burns Cases with Most Wounds of Superficial Partial-Thickness

Case 1 (fig 55a, b)

Fig 55 Anterior (above) and posterior (below) views a A 2.5-year-old baby patient, TBSA 70% b Discharged with

complete healing after treatment with MEBT/MEBO for only 14 days.

Clinical Demonstrations of Burns Regenerative Medicine and Therapy (MEBT/MEBO) on

Successful Treatment of Extensive Burns

131

Extensive Burns Cases with Most Wounds of Deep

Partial-Thickness

Case 2 (fig 56a–f)

Fig 56 a A 21-year-old man, TBSA 98% b 24 h after treatment with MEBT/MEBO c, d Regeneration of skin tissue

and wound healing on the 30th day after treatment with MEBT/MEBO.

(For fig 56e–f see next page.)

Fig 56 e At the present time f Three years post-treatment, the form, structure and function of the new skin is

identical to normal skin (chest and abdomen).

Case 3 (fig 57a–d)

Clinical Demonstrations of Burns Regenerative Medicine and Therapy (MEBT/MEBO) on

Successful Treatment of Extensive Burns

133

Fig 57 a A 28-year-old patient TBSA 82% b During the treatment

with MEBT/MEBO c Wound repair and physiological healing on the

32nd day after treatment with MEBT/MEBO Anterior and posterior

views d At the present time.

Extensive Burns Cases with Most Wounds of Full-Thickness

Case 4 (fig 58a, b)

Clinical Demonstrations of Burns Regenerative Medicine and Therapy (MEBT/MEBO) on Successful Treatment of Extensive Burns

135

Case 5 (fig 59a–c)

Fig 59 a TBSA 93% Before treatment b On the 9th day after

treat-ment with MEBT/MEBO c One year later after being healed and

discharged on the 46th day post-treatment with MEBT/MEBO.

Case 6 (fig 60a–c)

Fig 60 a Upper and lower: TBSA 90% Before treatment b Upper

(anterior) and lower (posterior) views: All wounds healed with skin

regeneration after 51 days of MEBT/MEBO treatment c At the

present time.

Clinical Demonstrations of Burns Regenerative Medicine and Therapy (MEBT/MEBO) on Successful Treatment of Extensive Burns

137

Case 7 (fig 61a–c, 62a–e)

Fig 61 a TBSA 90% Before treatment b The wound healed on the

43rd day after treatment with MEBT/MEBO c At the present time.

Fig 62 Three years later a The skin healed spontaneously from deep

second-degree wounds (chest and abdomen) and had identical ap-pearance as normal skin in structure and function Note the lack of

scar tissue b The skin healed spontaneously from wounds mixed of

deep second- and superficial third-degree burns (inside of left upper

arm) and recovered to normal structure and function c The skin

healed spontaneously from superficial third-degree wounds (back) and almost recovered to normal in structure without obvious scars.

(For fig 62d–e see next page.)

Fig 62 d The skin healed spontaneously from superficial third-degree wounds (outside of right thigh and knee) There

are few smooth and soft scars with slight hypo-pigmentation but good elasticity and no hyperplasia or dysfunction.

e The scars healed spontaneously from deep third-degree wounds (inside of right thigh and knee) Tissue appeared

smooth and soft without contracture or deformity.

Case 8 (fig 63a–c, 64a–e)