< TEXT-ALIGN: 0cm LINE-HEIGHT: 9.15pt; justify? 11.3pt; MARGIN: inter-ideograph;>Selection of the most appropriate dressing for any given type of wound is a laborious and complex process in view of the profusion of new and more elaborate dressing materials being proposed by the pharmaceutical industry. Various intricate algorithms proposed for wound care are impossible to memorize. Moreover they are practically very difficult to implement and render the task of dressing selection even harder. Not infrequently, whatever dressing is described to be the most appropriate in any given situation, may be impractical if not impossible to apply. If the basic principles of wound healing are respected and the aims and goals of the local wound management protocol are placed in proper perspective dressing selection need not be a seemingly desperate task. If a wound’s status permits spontaneous healing, the ideal dressing would be that which would promote wound healing. On the other hand, if healing is not expected either because of the wound’s extent or because of associated metabolic and vascular diseases, the main function of the dressing would be to prevent further tissue damage and to clean the wound surface and prepare it for subsequent surgical soft tissue coverage or maintain it in a relatively clean, socially acceptable condition. At any rate, the preferred dressing should be able to preserve wound exudates and maintain moisture over the wound surface. Further, it should constitute an effective barrier against bacteria and injurious external physical factors, and must reduce pain, be elastic and malleable [11]. Moreover, it must facilitate debridement whenever needed, and must have no antigenecity, toxicity or carcinogenicity. Reduced cost and unlimited or prolonged storage time are also factors to be considered [15]. Practical considerations with regard to dressing application and maintenance in position should not be overlooked as well.
< TEXT-ALIGN: 0cm LINE-HEIGHT: 9.15pt; justify? 11.3pt; MARGIN: inter-ideograph;>MOISTURE RETENTIVE OINTMENT < TEXT-ALIGN: 0cm LINE-HEIGHT: 9.15pt; justify? 11.3pt; MARGIN: inter-ideograph;>Moist Exposed Burn Ointment (MEBO – Julphar, Gulf Pharmaceutical Industries, UAE) is the latest addition to the multitude of newly developed passive, interactive, and active moist dressings. This product is, however, peculiar in the sense that it provides the moist environment for optimal healing without the need for an expensive, cumbersome and hard to apply overlying secondary dressing [19,20]. The ointment has been used traditionally in China for topical burn injuries treatment. Only two and a half decades ago, Xu Rongxiang [21] from the Beijing Chinese Burn Center has popularized it outside China. MEBO is a Chinese burn ointment with a USA patented formulation since 1995. The active component of the ointment is ß-sitosterol in a base of beeswax, sesame oil and other components. Clinical and experimental studies reported in the Chinese literature have demonstrated that it reduces markedly evaporation from the wound surface [22]. Though MEBO does not have any demonstrable in vitro bacteriostatic and bactericidal activity probably due to its oily composition that does not allow proper diffusion in a watery culture medium [23,24], it has been shown that in vivo, it had similar action to 1% Silver Sulfadiazine in controlling burn wound sepsis and systemic infection with P. aeroginosa [25]. It has also been demonstrated experimentally that MEBO exhibited a statistically significant wound healing potential on rabbit corneal epithelium as compared to saline, homologous serum, Vitamin A and dexamethasone [26]. The ointment produces good analgesia and has a good debriding effect, moreover, it drastically reduces water loss and exudation from the open wound surface. The required frequent application of the ointment is easy and can be performed by the patient himself or a member of his family. < TEXT-ALIGN: 0cm LINE-HEIGHT: 9.15pt; justify? 11.3pt; MARGIN: inter-ideograph;>CLINICAL TRIALS < TEXT-ALIGN: 0cm LINE-HEIGHT: 9.15pt; justify? 11.3pt; MARGIN: inter-ideograph;>The claim that the ointment effectively preserves moisture at the surface of partial thickness wounds has already been validated by both experimental studies and clinical trials [19,20,27,28,29,30,31]. When compared to the classical split thickness skin graft donor site dressing consisting of an antibiotic impregnated Vaseline gauze (Sofra Tulle®, Roussel Laboratories Ltd., Uxbridge, England) covered by a secondary bulky gauze dressing, moist exposed burn ointment promoted speedy healing with excellent cosmetic outcome [19,20,29]. Re-epithelialization of donor sites with ointment application was also better than dressing the donor sites with Tegaderm® (3M Health Care, St. Paul, MN), a moisture retaining semi-permeable adhesive film [30,31]. Earlier anatomical healing was observed with significantly superior cosmetic appearance of the resultant scars over a follow-up period of 6 months. The study demonstrated also significantly faster functional healing with restoration of cutaneous barrier function with ointment application. The observed positive correlation between improved scar quality and early physiologic recovery indicated that better cosmesis and improved function are closely linked. < TEXT-ALIGN: 0cm LINE-HEIGHT: 9.15pt; justify? 11.3pt; MARGIN: inter-ideograph;>rophylactic MEBO application for a period of 6 weeks after wound suturing resulted also in cosmetically better scars at 1, 3, and 6 months when compared to a control no treatment group and another group treated with topical antibiotic application (Fucidin®, Leo Pharmaceutical, Danmark) [1,32]. Though significant differences in scores for color, contour, distortion, and aspect between the 3 groups were observed with more favorable scores for the moisture retentive ointment group, only color scores exhibited significant changes over time. At 6 months, the observed color difference among the 3 groups becomes non-significant. It is, however, extremely significant at 1 and 3 months indicating that the permanent scar color may be expected at an earlier stage whenever the scar is managed prophylactically with MEBO. Of all the parameters, only differences in texture values reflecting deeper dermal healing became extremely significant at 6 months while these were less significant at 1 and 3 months, indicating a net divergence in fibroblastic and scar remodeling activity between the treatment groups in favor of moist exposed burn ointment. A clinical trial treating various types of chronic ulcers with daily MEBO application was also conducted [33,34]. An extremely significant reduction in ulcer surface area and increase in healing index (HI) over the first 3 weeks of treatment was noted. Healing, However, was more pronounced in the non-neurotrophic ulcers. When healing data of neurotrophic ulcers was analyzed using the paired t-test, significant increase in HI between weeks one and two became apparent. The same healing trends were also observed when ulcers of vascular etiology without a neurotrophic component were considered. More than 50% of all ulcers reached 0.25 Healing Index (HI) within the first week, more than 80% within the second week, and more than 90% within the third week. 100% of the non-neurotrophic ulcers reached 0.25 HI by the third week while only 80% of the neurotrophic ulcers reached the same stage of healing. 50% of all ulcers reached 0.75 HI by the second week, and around 80% by the fourth week, while 85% of non-neurotrophic and about 65% of neurotrophic ulcers reached 0.75 HI by the fourth week. None of the patients in the study had initially wound sepsis nor did any patient develop clear signs of wound sepsis during treatment irrespective of the treatment duration, which extended for more than 3 months in few patients for which surgery was not an option. |