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楼主:星月 - 

[原创]湿润烧伤膏的使用问答(依据个人使用经验认识所得,供参考)

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 楼主| 星月 发表于 2005-10-16 10:14:00 | 显示全部楼层
<>相关研究,仅供参考。举下列研究论文和例子,并不代表个人赞同或者否定态度,仅作为部分参考,本人非医务人员和医学研究者,所作工作仅为本人在医治本人爱人的过程中所理解和认识(有局限的)的部分依据。本人此观点和看法仅为本人自己所思所想,并不代表医学界的最终认定或可知的权威看法等等(因为本人不具备对医学研究的最终论断),本人过去所作之结论,均为个人之看法、意见,只能作为各位P友治疗银屑病的参考,如果本人在相关论断上有问题或者文理不通或者错误,请观者原谅并以审慎的态度来发表看法或者采取与本人方法相关的治疗手段、措施。如果患者不能确定美宝湿润烧伤膏的安全性或者认为不能安全的用于P病治疗或者烧伤治疗等等,那么,请勿采用本人提供之方法!!请仔细阅读上述文字!


<>本人声明:本人不负担因治疗方法、方式或体质因素等造成与本人治疗效果迥异的情况和与此可能相关的法律责任!谢谢!


<>http://www.etrs.org/bulletin11_1/section7.htm


<>





<>EUROPEAN TISSUE  REPAIR SOCIETY

NEWS FROM BEIRUT





< align=center>MOIST WOUND HEALING AND MOIST EXPOSED THERAPYrofessor Bishara S. Atiyeh and Dr Shady N. Hayek
American University of Beirut Medical Center, Beirut, Lebanon


<>Introduction

Wound healing is a complex and highly regulated process that can be compromized by both endogenous and exogenous factors.1 In both primary and secondary healing it consists of a series of events characterized by inflammation, epithelialization, connective tissue deposition and contraction. The contribution of each event varies according to the type of wound.2 At any rate, the longer it takes for spontaneous wound healing to be completed, the worse the outcome usually is, with increasing likelihood of developing hypertrophic scarring and unsightly alterations in pigmentation. Moreover, under unfavorable conditions, the self-perpetuating inflammatory cascade may result in increasing tissue destruction and necrosis rather than healing.3,4 On the other hand, understanding the concept of occlusion has been fundamental to the evolution of our knowledge about wound healing leading to the development of new wound dressings and has created a paradigm shift in the management of wounds.6,7,8,9,10 Before this understanding, wounds often were kept dry, as advocated by Pasteur to keep them ‘germfree‘.6 There is now growing evidence of improved healing of full- and partial-thickness cutaneous wounds in wet and moist environments. Retention of biologic fluids over the wound prevents desiccation of denuded dermis or deeper tissues and allows faster and unimpeded migration of keratinocytes over the wound surface. It allows also the naturally occurring cytokines and growth factors to exert their beneficial effect on wound contracture and re-epithelialization. Enthusiasm generated by these results has been, however, tempered by concerns over tissue maceration and infection following prolonged cutaneous water exposure.2,11 These concerns may not be justified.2,12,13 Nevertheless, despite mounting evidence and appreciation of the biologic beneficial factors of moist environments, applying the moist healing principles to large surface areas, in particular to large burns and skin graft donor sites, is hindered by the major impracticality and technical handicap of creating and maintaining a sealed moist environment over these areas.5,14,15

Dressings have been used since antiquity to facilitate the healing process. More recently many sophisticated dressings have become available to the wound care practitioner. These newer materials and agents supplement older dressing materials, such as gauze, which still are commonly used.6 Wound dressings provide several important functions including protection, prevention of infection, promotion of healing through keeping the wound moist and warm, reduction of pain, absorption of exudate, comfort, stability and reduction of wound motion. Dressings should also be easy to apply and remove without causing further trauma. Although there is not one ideal dressing capable of providing all these functions, and not every wound requires every attribute, yet a wound may need a different dressing as it progresses through the healing process.6,7,8 Different dressing materials, devices and agents provide different functions to greater or lesser degrees, and the attributes of each need to be matched to the specific wound on which it is placed.6


<>Moist Exposed Burn Ointment

Since recent evidence suggests that moist environment favors more optimal healing, and since currently available moisture retentive devices cannot be universally applied, clinical trials were conducted to evaluate the efficacy of a newly introduced moisture retentive ointment, MEBO (Moist Exposed Burn Ointment) (Julphar Gulf Pharmaceutical Industries, UAE), on primary healing of surgically repaired wounds and on re-epithelialization of partial thickness wounds. The ointment is capable of providing an optimal moist environment without the need of an overlying occlusive dressing. MEBO is a Chinese burn ointment with a USA patented formulation since 1995. The active component of the ointment is b-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.15 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,16,17, 26,27 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.18,28 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.19 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. The most remarkable practical advantage of MEBO over other types of dressings is that it provides an effective wet environment favorable for optimal wound healing without the need of any covering or occlusive dressing. In some cases, however, particularly when the patient is not confined in bed or at home, a simple covering dressing may be more convenient.


[此贴子已经被作者于2005-10-16 14:11:42编辑过]
 楼主| 星月 发表于 2005-10-16 11:09:00 | 显示全部楼层

http://www.burn-recovery.org/burn-research.htm


Recent Burn Treatment Research


1) A new dressing helps treat graft donor sites on burn patients.


<>Temporary dressings are used for a variety of reasons on serious burn wounds. One new product is called OrCel and uses layers of human skin cells (from someone other the donor) and collagen (a tough connective tissue) from cows to make a dressing that can be applied to a burn wound or donor graft site for two to three weeks and then removed. A study compared the effectiveness of OrCel with a product that has been in use for decades and is composed of layers of silicone, nylon, and collagen from pigs. The researchers concluded that partial thickness donor sites healed more quickly with OrCel dressings than with the standard product. One advantage of early healing is that a donor site can potentially be reused for another graft after the area heals. Burns. 2003 Dec; 29(8): 837-41.


2) Moist exposed burn ointment may reduce hypertrophic scarring.


<>Researchers investigating hypertrophic scars (scars that grow above or outside the wound) have been limited because animals do not form hypertrophic scars. As a result, experiments using animals rather than people are not helpful in developing new treatments for people (regardless of one’s beliefs about animal experimentation). Researchers in Lebanon evaluated whether different types of wound dressings may help prevent hypertrophic scarring. The wounds that were treated were either donor sites for partial thickness skin grafts or wounds that were allowed to heal without grafting or surgical closure. The researchers concluded that patients treated with moist exposed burn ointment (MEBO) had less hypertrophic scarring than patients treated with dressings, Tegaderm, or antibiotic ointment. Aesthetic Plastic Surgery. 2003 Dec 4.


3) Full thickness skin grafts are helpful in treating burn wounds on the face.


<>Because of the cosmetic importance of skin on the face, facial burns are a particular challenge. For 15 to 20 years the study researchers followed 18 patients who had received full thickness skin grafts for facial burns. The grafted skin was able to sweat, had oil glands, and was elastic. Partial thickness grafts don’t have sweat or sebaceous (oil) glands. When looked at under a microscope, the grafted skin looked more like regular facial skin than skin from the area of the donor site. The researchers suggested that full thickness grafts for facial burns may produce the best results. Zhonghua Zheng Xing Wai Ke Za Zhi. 2003 Jul; 19(4): 276-8.


4) A new product helps in the healing of burn wounds on the hand.


<>French researchers studied the use of a product called Integra Dermal Regeneration Template for deep hand burns. Integra was used to cover the wounds either immediately after hospitalization or later during reconstructive surgery. Integra has two layers: 1) a permanent bottom collagen layer (from cows) that is a substitute for the dermal layer of the skin (the layer beneath the epidermis, which is the top layer of the skin); and 2) a top silicone layer that is a temporary substitute for normal epidermal skin. Two to three weeks after the wound is covered with Integra, the silicone layer is removed and replaced with a very thin donor graft of epidermal skin. Using thin epidermal skin grafts instead of thicker split thickness grafts has two potential advantages. The donor site looks more like normal skin after it has healed because there is less scarring when a thinner graft is removed. The donor site also heals much more quickly and can thus be “re-harvested” more quickly for additional grafts. The layer of collagen is left in place as a substitute dermal layer of skin and supports the donor epidermal graft (hence the name “regeneration template”).The researchers found that Integra worked well. There was a 100% “take” of the grafts and the grafted skin was flexible and supple enough to allow easy use of the joints in the fingers and hands. The cosmetic result was judged to be satisfactory. British Journal of Plastic Surgery. 2003 Dec; 56(8): 764-74.


5) A new dressing for second degree wounds helps prevent infection.


<>A new dressing product is being investigated in France. It has been tested on patients with second degree wounds. None of the patients developed infections and for those patients who had grafts, all of the grafts “took.” The product saturates a new type of dressing (lipidocolloid) with sulfasalazine, which has long been used in burn units to prevent infections. J Wound Care. 2004 Apr; 13(4): 145-8.


6) Tissue expanders are helping in the treatment of some pediatric burn patients.


<>One way of growing additional skin is with tissue “expanders.” A surgeon (usually a plastic surgeon) places a balloon under the skin and then gradually inflates the balloon with salt water. As the balloon gets bigger, the skin covering the balloon expands by growing new skin. After the skin expands, a “flap” of the expanded skin is used to cover a nearby area of skin that needs to be replaced. There are several advantages of tissue expansion. First, the expanded skin will be a good match in terms of color, texture, thickness, and the amount of hair. This is particularly important in areas such as the scalp and face. Second, because the skin doesn’t need to be moved, there is usually less visible scarring. Third, the blood supply for the skin flap remains intact and so the likelihood that the flap will take is higher than when skin is moved from a graft site. Fourth, the nerve supply in the flap is not cut and so the person will have feeling in the flap. The disadvantages of tissue expanders include the time it takes to expand the skin (up to three or four months); the unsightly bulge that occurs as the balloon is inflated; the possibility that the expander will rupture and require additional surgery; and the possibility of infection in the area of the expander. The article discusses the use of tissue expanders in children, including burn survivors. Because of the time tissue expansion requires, use in burn patients is limited to reconstructing scarred areas with healthy nearby skin. J Craniofac Surg. 2003 Nov; 14(6): 866-72.


7) Exercise is important in preventing contractures.


<>A “contracture” is a shortening or shrinking of tissue. Grafted skin and scars shrink. When shrinkage occurs near joints and other moving body parts, such as the fingers and the eyelids, it can make movement much more difficult. Contractures can also occur when a part of the body isn’t used normally. For example, burn survivors who must keep a limb in a particular position to allow for healing of a graft or wound may experience shortening of the tendons or ligaments in that limb. When tendons and ligaments shorten, normal range of motion in the limb is lost. Such contractures may have to be “released” surgically. Exercise is one important way to prevent contractures. The author reports on the exercises used by a patient who had developed contractures requiring surgery to regain flexibility and prevent contractures from recurring following the surgery. J Burn Care Rehabil. 2003 Nov-Dec; 24(6): 378-81.


8) Thymus oil may be helpful in burn wound healing.


<>When burns occur there are very complicated responses by the body, some of which are poorly understood. One chemical produced by the body in larger amounts than normal following a burn injury is nitrous oxide, which can potentially cause further damage to wounded tissues. One hypothesis is that increased nitrous oxide may reduce blood supply to injured tissue by increasing the tendency of blood to clot. Researchers have investigated whether naturally occurring substances may help with wound healing. One such substance is thymus oil, which is known to have antiseptic and antioxidant properties. It was found that thymus oil decreased the levels of nitrous oxide in burn patients and promoted the formation of new skin. J Burn Care Rehabil. 2003 Nov-Dec; 24(6): 395-9.


9) Light therapy may help diabetic burn survivors.


<>Wound healing is usually a much bigger problem for people with diabetes than for people who don’t have diabetes. Diabetes affects blood vessels and can reduce the blood supply to the body’s tissues. Because blood transports oxygen, nutrients, and cells that are important for wound healing, a reduction in blood supply slows healing, including healing of burns. Researchers in Saudi Arabia performed experiments to determine whether a particular type of light (polychromatic light emitting diodes (LED)) stimulated healing of burn wounds in diabetic rats and nondiabetic rats. They concluded that LED light encouraged wound healing for the diabetic rats but not for rats without diabetes. Journal of Clinical Laser Medicine and Surgery. 2003 Oct; 21(5): 249-58.


10) Why don’t cultured epithelial autografts always take?


<>Swiss researchers are investigating why cultured epithelial autografts (CEA’s) don’t always “take.” A CEA is produced by removing living, unburned skin cells from a burn patient and using those cells to grow thin sheets of new cells in a laboratory. A CEA is then grafted back onto the burn patient. There are two major advantages of CEA’s. First, “autografts” (grafts from the patient’s own skin) are not limited to areas of the patient’s unburned skin. New “skin” can be grown. This is particularly important for patients with extensive burns. Second, the grafts are not rejected by the patient’s immune system because the grafts are “recognized” by the immune system as being part of the person’s own body. One problem with the grafts has been that, on average, about 35% of CEA’s don’t end up taking; i.e., they don’t bond with the tissue beneath the graft. The Swiss researchers focused on the percentage of the cells in a CEA that continue to live following the grafting procedure. They found that more than 90% of the cells survived, leading them to conclude that early death of the cultured cells is not a good explanation for the failure of a CEA to take. The researchers did find that other biological processes occurring in cells varied a great deal between individuals and might explain why CEA’s take in some patients and not in others. International Journal of Artificial Organs. 2003 Sep; 26(9): 793-803.


11) Porcine wound models for skin substitution and burn treatment.


Skin regeneration is an important field of tissue engineering. Especially in larger burns and chronic wounds, present treatments are insufficient in preventing scar formation and promoting healing. Initial screening of potentially interesting products for skin substitution is usually done by in vitro tests. Before entering the clinic, however, in vivo studies in immunocompetent animals are necessary to prove efficacy and provide information on safety aspects.


We have obtained extensive experience using the domestic pig as test animal for studies on skin replacement materials, including tissue engineered skin substitutes, and burn wound treatment.


Two models are described: an excisional wound model for testing of dermal and epidermal substitutes and a burn wound model for contact and scald burns, which allows testing of modern wound dressings in comparison to the present gold standards in burn treatment. The results of these experiments show that in vivo testing was able to reveal (dis)advantages of the treatments which were not detected during in vitro studies.
Biomaterials. 2004 April Pages 1559-1567


News


Bacterial cellulose retains water and promotes 'moist' healing






If you are a burn survivor or a family member or friend of a burn survivor and would like to receive a FREE Burn Recovery Center information packet or to make a request, please fill out the following form (U.S. only please) or call us at 1-877-640-3200:


[此贴子已经被作者于2005-10-16 11:11:17编辑过]
 楼主| 星月 发表于 2005-10-16 10:26:00 | 显示全部楼层
Moist exposed burn ointment (MEBO) has been used traditionally in China for topical burn injuries treatment and was explored by Xu Rongxiang20 from the Beijing Chinese Burn Center. It has been popularized outside China only two and a half decades ago. Reports about its properties and functions have been published in the Chinese literature; there was, however, a need to independently document the claimed benefits of this ointment in wound healing. Chinese traditional medicine (CTM) is quite different from the type of medicine and approach to disease as practiced in the west. Amongst our frenetic drive to develop more and more sophisticated and active wound healing devices and treatment modalities, it is wrong, however, to totally disregard CTM and its empirically time proven practices and remedies. It is difficult though to accept CTM without somehow adapting it to our ways of scientific analysis and documentation.21< align=center>

Figure I: (A) Healed STSG donor site at 2.5 months.
Note better cosmetic result of the area treated with moist exposed burn ointment (MEBO®).
Note also epidermal sliding present in the area treated by Sofra-Tulle ®.
Demarcation zone between the two treatment areas indicated by arrow.
(B and C) STSG donor sites treated by MEBO® and Tegaderm®.
Better healing with better cosmetic result observed with MEBO®.

< align=left>Clinical Trials

We as well as others have already validated the claim that the ointment effectively preserves moisture at the surface of partial thickness wounds by both experimental studies and clinical trials. Results have already been published documenting better re-epithelialization.21,22,23,24,25,26,27,28 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 bulky gauze dressing, moist exposed burn ointment promoted speedy healing with excellent cosmetic outcome.23,24,25 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 film27,28 (Figure 1). MEBO treatment resulted in earlier anatomical healing with significantly superior cosmetic appearance of the resultant scars over six months follow-up. 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.
When evaluating primary healing using the visual analogue scale,29 cosmetically better scars consistent with lower scores are observed following prophylactic MEBO application for a period of six weeks after wound primary suturing at one, three, and six months when compared to a control no treatment group and another group treated with topical antibiotic application (Fucidin®, Leo Pharmaceutical, Danmark)30,31 (Figure 2). Though significant differences in scores for colour, contour, distortion, and aspect between the three groups were observed with more favorable scores for the MEBO treated group, only colour scores exhibited significant changes over time. At six months, the observed colour difference among the three groups becomes nonsignificant. It is, however, extremely significant at one and three months indicating that the permanent scar colour 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 six months while these were less significant at one and three months, indicating a net divergence in fibroblastic and scar remodeling activity between the treatment groups in favor of moist exposed burn ointment.

< align=center>

Figure 2: Improved scar quality of primarily
healed facial lacerations.

<>Conclusion

Our investigation of this new moisture retentive ointment indicates so far that it has a definite positive effect on wound healing. The nature of the studies and their limited clinical scope, allow us, however, only to speculate on its mechanism of action as well as on its effect on the various phases and components of the wound healing cascade. Further research is still required to explore the bio-cellular mechanisms involved and its action on the different cytokines and metalloproteinases proven lately to be essential in determining the final outcome of healing. These reported studies as well as another prospective clinical trial of this ointment in topical treatment of chronic ulcers32,33 have demonstrated the extreme ease of application and practicality of this ointment in providing the necessary moist conditions for optimal healing as compared to currently available labor intensive and time consuming moisture retaining products and devices. Though it is not an antibiotic and definitely not suitable for the treatment of established wound sepsis, adequate local antibacterial action of the ointment maintaining open wounds in a healthy ‘none infected’ condition has also been demonstrated. Even when used for prolonged periods of time, emergence of resistant strains was not observed.32,33

 楼主| 星月 发表于 2005-10-16 10:26:00 | 显示全部楼层
<>References

1. Bowler PG. Wound pathophysiology, infection and therapeutic options. Ann Med 2002; 34: 419–427.
2. Grinnel F. Fibroblasts, myofibroblasts, and wound contraction. J Cell Biol 1994; 124: 40–44.
3. Grossman PH, Grossman AR. Treatment of thermal injuries from CO2 laser resurfacing. Plast Reconstr Surg 2002; 109: 1435–42.
4. Spence RJ, Wong L. The enhancement of wound healing with human skin allograft. Surg Clin North Am 1977; 77: 731–745.
5. Atiyeh BS, El-Musa KA, Dham R. Scar quality and physiologic barrier function restoration after moist and moist-exposed dressings of partial-thickness wounds. Dermatol Surg 2003; 29: 14–20.
6. Lionelli GT, Lawrence WT. Wound dressings. Surg Clin North Am 2003; 83: 617–38.
7. Thomas DR, Kamel HK. Subacute care for seniors, Clin Geriat Med 2000; 16: 783–804.
8. Pearson AS, Wolford RW. Management of skin trauma. Dermatology 2000; 27: 475–92.
9. Mostow EN. Wound healing: A multidisciplinary approach for dermatologists. Dermatol Clin 2003; 21: 371–387.
10. Brem H, Nierman D, Nelson JE. Pressure ulcers in the chronically critically ill patient. Critical Care Clin 2002; 18: 683–694.
11. Winter GD. In: Epidermal regeneration studied in the domestic pig. Maibach HI, Rovee DT (eds). Epidermal wound healing. Year Book Medical Publishers, Inc. Chicago 1972, 71–112.
12. Vogt PM, Andree C, Breuing K, Liu PY, et al. Dry, moist, and wet skin wound repair. Ann Plast Surg 1995; 34: 493–499.
13. Reuterving CO, Agren MS, Soderberg TA, Tengrup I, et al. The effects of occlusive dressings on inflammation and granulation tissue formation in excised wounds in rats. Scand J Plast Reconstr Surg 1989; 23: 89–96.
14. Jonkman MF, Hoeksma EA, Nieuwenhuis P. Accelerated epithelialization under a highly vapor-permeable wound dressing is associated with increased precipitation of fibrin(ogen) and fibronectin. J Invest Dermatology 1990; 94: 478–84.
15. Wang GS, Zhang YM, Liu RS, et al.: Experimental study of the Effect of MEBO on blood rheology in the treatmet of burned rabbits. Chinese J Burns Wounds Surf Ulcers 1993; 5 (4): 30–32.
16. Qu YY, Wang YP, Qiu SC et al.: Experimental research on the anti-infective mechanism of MEBO. Chinese J Burns Wounds Surf Ulcers 1996; 8 (1): 19–23.
17. Xing D: Experimental study on the actions of the moist burn ointment on promoting healing of skin wound and anti-infection. Chinese J Burns Wounds Surf Ulcers 1989; 1 (1): 75–76.
18. Geng XL, Bu XC, Gao FQ, Liu YL: Study on the bacterial count in the subeschar living tissues of burn wounds. Chinese J Burns Wounds Surf Ulcers 1989; 1 (1): 49–50.
19. Huang QS, Zhou G, Su BP, Huang EX: A comparative study of fibronectin and MEBO in the treatment of experimental rabbit corneal alkaline burn. Chinese J Burns Wounds Surf Ulcers 1995; 7 (1): 18–9
20. Xu R: the medicine of burns and ulcers, a general introduction. Chinese J Burns Wounds Surf Ulcers 1989; 1 (1): 68
21. Atiyeh BS, Ioannovich J, Magliacani G, Masellis M, Costagliola M, Dham R, Al-Musa K A. A new approach to local burn wound care: moist exposed therapy, a multi-phase, multicenter study. J Burns & Surg Wound Care [serial online] 2003; 2:18. Available from: URL: http://www.journalofburns.com
22. Ioannovich J, Tsati E, Tsoutsos D, Frangia K, et al. Moist exposed burn therapy: evaluation of the epithelial repair process (an experimental model). Ann Burns Fire Disast 2000; 8: 3–9.
23. Atiyeh BS, Ioannovich J, Al-Amm CA. Pansements de sites donneurs de greffe de peau mince: resultats preliminaires d’une etude clinique limitee comparative de ‘MEBO’ et de ‘sofra-tulle’. Brûlures, Revue Française de Brûlologie 2000; 1: 155–61.
24. Atiyeh BS, Ghanimeh G, Kaddoura IL, Al Amm C, Ioannovich J. Split thickness skin graft donor site dressing: preliminary results of controlled clinical comparative study of MEBO and sofra-tulle. Letter-to-the-editor. Ann Plast Surg 2001; 46: 88–89.
25. Atiyeh BS, Al-Amm CA, Nasser AA. Improved healing of split thickness skin graft donor sites. J Applied Research 2002; 2: 114–21.
26. Ang ES, Lee ST, Gan CS, See P, et al.: The role of alternative therapy in the management of partial thickness burns of the face – experience with the use of moist exposed burn ointment (MEBO) compared with silver sulphadiazine. Ann Acad Med Singapore 2000; 29: 7–10.
27. Atiyeh BS, Al-Amm CA, El-Musa KA, Sawwaf A, Dham R. Scar quality and physiologic barrier function restoration following moist and moist exposed dressings of partial thickness wounds. Dematol Surg 2003; 29: 14–20
28. Atiyeh BS, Al-Amm CA, El-Musa KA, Sawwaf A, Dham R. The effect of moist and moist exposed dressings on healing and barrier function restoration of partial thickness wounds. Eur J Plast Surg 2003: 26: 5–11.
29. Beausang, E, Floyd, H, Dunn, KW, Orton, GI et al. A new quantitative scale for clinical scar assessment. Plast Reconstr Surg 1998; 102: 1954–61.
30. Atiyeh, BS, Ioannovich, J, Al-Amm, CA, El-Musa, KA, Dham, R. Improving scar quality: A prospective clinical study. Aesth Plast Surg. 2002; 26: 470–6.
31. Atiyeh BS, Amm CA, El Musa KA. Improved scar quality following primary and secondary healing of cutaneous wounds. Aesth Plast Surg 2003; 27: (in press).
32. Atiyeh BS, Ioannovich J, Magliacani G, Masellis M, Costagliola M, Dham R. The efficacy of moisture retentive ointment in the mangement of cutaneous wounds and ulcers: a multicenter clinical trial. Indian J of Plast Surg 2003; 36: 89–98.
33. Atiyeh BS, Ioannovich J, Magliacani G, Masellis M, Costagliola M, Dham R. The efficacy of MEBO (moist exposed burn ointment) in the management of cutaneous wounds and ulcers: a pilot study. Letter-to-the-editor, Ann Plast Surg 2002; 48: 226–7.

<>Bishara S. Atiyeh, MD, FACS
Clinical Professor
Division Plastic and Reconstructive Surgery
American University of Beirut Medical Center
Beirut, LEBANON

<>Shady N. Hayek, MD
Chief Resident
Division Plastic and Reconstructive Surgery
American University of Beirut Medical Center
Beirut, LEBANON

<>Responsible Author and Reprint Requests:
Bishara S. Atiyeh, MD, FACS.
Clinical Professor
Division of Plastic and Reconstructive Surgery
American University of Beirut
Beirut, Lebanon
Tel: (916) 3 340032
Fax: (961) 1 363291
E-mail: aata@terra.net.lb

Return to Bulletin 11.1 & Contents


< align=center>Designed by the eDoodle group

 楼主| 星月 发表于 2005-10-16 14:57:00 | 显示全部楼层
< 0cm 0cm 34.75pt; TEXT-ALIGN: center" align=center>MOISTURE AND WOUND HEALING

< 0cm 0cm 11.75pt; LINE-HEIGHT: 11.55pt">Bishara S. ATIYEH, MD, FACS Shady N. HAYEK, MD Clinical Professor Chief Resident Division Plastic and Reconstructive Surgery Division Plastic and Reconstructive Surgery American University of Beirut Medical Center American University of Beirut Medical Center Beirut, LEBANON Beirut, LEBANON e-mail: aata@terra.net.lb

< 0cm 0cm 11.75pt; LINE-HEIGHT: 11.55pt">Correspondance to B. S. Atiyeh

< 0cm 0cm 0pt">This article was originally published in French as:

< 0cm 0cm 11.75pt; LINE-HEIGHT: 11.55pt">Intérêt d'un Onguent Chinois (MEBO) dans le Maintient Local de l'Humidité.
Bishara S. Atiyeh, Shady N. Hayek. Journal des Plaies et Cicatrisation
9:7-11,2005.
It is reproduced here in English by kind permission of the publishers JPC.

< 0cm 0cm 9.15pt; LINE-HEIGHT: 11.55pt">ABSTRACT

< 0cm 0cm 9.15pt; LINE-HEIGHT: 11.55pt">Good hydration is the single most important external factor responsible for optimal wound healing. Unfortunately, available moisture retentive materials, products and devices require a certain expertise for application, are relatively expensive, may be associated with some serious complications and side effects, but most of all are impractical for application over large surface areas. We present our experience in exploring the wound healing effect of Moist Exposed Burn Ointment (MEBO – Julphar, Gulf Pharmaceutical industries, UAE), a newly introduced product capable of providing optimal moisture at the wound surface without overlying secondary occlusive dressing. Though the studies we have conducted have a limited scope, they have, however, demonstrated improved primary and secondary wound healing as well as extreme ease of application and practicality of this ointment in providing the necessary moist conditions for optimal healing as compared to some currently available labor intensive and time consuming moisture retaining products and devices. They have demonstrated also the beneficial prophylactic effect of the ointment on scar quality.

< 0cm 0cm 9.15pt; LINE-HEIGHT: 11.55pt">INTRODUCTION

< 0cm 0cm 9.15pt; LINE-HEIGHT: 11.55pt">Wound healing which is the stated goal of any wound management protocol, has been described throughout recorded history, however, our understanding of its basic mechanisms has grown more in the past 2 decades than in the preceding 2 millennia [1]. The recent logarithmic growth in our knowledge about wound healing is extremely promising and has already led to the introduction of new and exciting concepts as well as several novel therapeutic modalities and innovative wound dressings [2]. There is now growing evidence that good hydration is the single most important external factor responsible for optimal wound healing [3,4,5,6,7]. Although no reliable operational definitions exist of too little or too much wound surface moisture, moist wound healing is one of the most frequently used, but least understood terms in wound care nowadays. Moist or wet wounds may not be significantly different [8]. Despite some evidence that full-thickness skin wounds may exhibit accelerated healing in a wet environment in contradistinction to a moist environment [5], the optimum environment for wound healing may be an intermediate gelatinous environment between moist and dry such as seen under highly vapor-permeable dressings [8,9]. Irrespective of this apparent controversy, allowing traumatized or ischemic tissues to dehydrate produces further tissue loss by transforming the "zone of stasis" adjacent to the zone of injury into a "zone of necrosis" [5,10,11].

Healing under both wet and moist environments has been clearly demonstrated to be significantly faster than under dry conditions. Possible mechanisms explaining the observed improved healing include easier migration of epidermal cells over the moist wound surface instead of under a dry scab, increased partial pressure of oxygen, and the preservation of growth factors and proteinases present in fluid exudates that are hence allowed to exert their potentiating effect on wound healing [5]. Increased moisture is responsible also for a decrease in capillary activity, reduced hyperemia, and reduced collagen deposition [10,12]. It is well proven also that keratinocytes need a moist milieu to down-regulate fibroblast collagen deposition [12] and that collagenolysis is enhanced by hydration [13]. Clinical healing of similar wounds during similar time-frames follows patterns that can be predicted by dressing moisture retention. This observa­tion suggests that, when other variables are held constant, use of more moisture-retentive dressings generally achieves environments supportive of earlier healing outcomes when compared with less moisture-retentive dressings [14]. Despite mounting evidence and appreciation of the biologic factors of moist environments and their ability to promote rapid infection-free re-epithelialization with less pain [13,15,16], the advantages of water-impermeable occlusive dressings on wound healing are often offset by their impracticality particularly when applied to large split thickness donor site areas or extensive burn surfaces [15]. Enthusiasm generated by better healing under moist conditions has also been tempered by concerns over the unwelcomed tissue maceration and infection following prolonged cutaneous water exposure [4,17]. These concerns may not be justified. In fact prolonged exposure of skin to physiologic fluids such as amniotic fluid [18] or saline [4] does not seem to produce maceration and is not comparable to the conditions encountered in World War I associated with trench foot [4]. Anyway, evidence suggests that maceration is not consistently associated with increased adverse events, on the contrary, greater dressing moisture retention is associ­ated with fewer clinical infections, greater patient comfort, and reduced scarring [14].
 楼主| 星月 发表于 2005-10-16 14:58:00 | 显示全部楼层
< 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.

 楼主| 星月 发表于 2005-10-16 14:58:00 | 显示全部楼层
< inter-ideograph; MARGIN: 0cm 0cm 11.75pt; LINE-HEIGHT: 11.3pt; TEXT-ALIGN: justify">DISCUSSION

< inter-ideograph; MARGIN: 0cm 0cm 9.15pt; LINE-HEIGHT: 11.3pt; TEXT-ALIGN: justify">Despite all the recent accumulation of knowledge regarding wound healing, local wound care for wounds to heal either by primary or by secondary intention appears to be still a balance of art and science invariably based upon experience and perhaps upon perceived cost and benefit passed from teacher to student [35]. There are currently hundreds of products, devices, and dressing materials in the market to aid in wound management [11]. However, before selecting the appropriate dressing that would provide maximal benefit for a particular wound, the needs of the wound must be carefully assessed [36]. As mentioned previously, no single dressing can provide all requirements to all wounds and no available agent is perfect. Moreover, the needs of each individual wound at any particular time need to be prioritized as it may differ while it progresses through the healing process. These needs must be matched to the pros and cons of possible dressings. Frequently, there is not one clear best choice. The practitioner must decide which dressing functions are required for each particular situation in order to maximize the choice among the possibly acceptable dressing candidates [37]. The choice of dressing depends on the type of wound, its anatomic location, the patient's age, how often it needs to be changed, and the function it has to perform. Factors to consider in the type of wound include size, depth, presence of infection or pain, and amount of exudates [37,38]. Moreover, treatment decisions should be made within the context of the patient's overall care goals [39].

< inter-ideograph; MARGIN: 0cm 0cm 9.15pt; LINE-HEIGHT: 11.3pt; TEXT-ALIGN: justify">With regard to these basic principles, any dressing that does not provide the necessary moisture for wound healing should be disregarded except probably when dealing with infected wounds in which the moist environment would exacerbate the infection [11]. Though some dressings may be beneficial in some aspects such as the widely used topical antibacterial preparations in burn wound management and the highly absorbent cotton and gauze dressings, such open and semi-open dressings violate the basic principle of wound healing and must be replaced by better alternatives. Adherent wet to dry dressings, low adherent wound contact dressings and perforated film absorbent dressings do not seem to be appropriate for the management of open wounds healing by secondary intention. Their usage for primarily healing wounds is not so much objectionable. On the other hand, foam dressings, polysaccharide dressings and alginate dressings do not provide as such the optimum moist environment for healing unless combined with a secondary synthetic adhesive moisture-vapor-permeable (SAM) dressing which by itself is labor intensive and impractical to use over large surface areas and difficult to maintain over certain anatomical areas. Likewise, hydrocol­loids, hydrogels and the new hydroactive preparations though capable of providing the proper moisture, require the same secondary dressing for positioning. MEBO, on the other hand, produces the adequate environment for moist wound healing without the need of any cumbersome, elaborate or expensive secondary dressing [11].

< inter-ideograph; MARGIN: 0cm 0cm 9.15pt; LINE-HEIGHT: 11.3pt; TEXT-ALIGN: justify">CONCLUSION

Our investigation of this new moisture retentive ointment indicates so far that it has a definite positive effect on wound healing. The nature of the studies and their limited clinical scope, allow us, however, only to speculate on its mechanism of action as well as on its effect on the various phases and components of the wound healing cascade. Further research is still required to explore the bio-cellular mechanisms involved and its action on the different cytokines and metallopro­teinases proven lately to be essential in determining the final outcome of healing. These reported studies have demonstrated the extreme ease of application and practicality of this ointment in providing the necessary moist conditions for optimal healing as compared to currently available labor intensive and time consuming moisture retaining products and devices. Though it is not an antibiotic and definitely not suitable for the treatment of established wound sepsis, adequate local antibacterial action of the ointment maintaining open wounds in a healthy “none infected” condition has also been demonstrated. Even when used for prolonged periods of time, emergence of resistant strains was not observed [33,34]. The prophylactic effect of MEBO application on improving the cosmetic appearance and preventing pathologic scar formation is another important beneficial aspect that needs further investigation.
 楼主| 星月 发表于 2005-10-16 14:59:00 | 显示全部楼层
< inter-ideograph; MARGIN: 0cm 0cm 11.75pt; LINE-HEIGHT: 11.3pt; TEXT-ALIGN: justify">REFERENCES

< inter-ideograph; MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: justify">1-Atiyeh BS, Ioannovich J, Al-Amm CA, A. El-Musa KA, Dham R. Improving Scar Quality: A Prospective Clinical Study. Aesthetic

< 0cm 0cm 0pt; TEXT-INDENT: 18pt">lastic Surgery 26: 470, 2002 2-Cohen KI. Wound healing: Key advances in research and clinical care. Contemp Surg Suppl Sept: 2, 2000 3-Winter GD. A note on wound healing under dressings with special reference to perforated-film dressings. J Investig Dermatol 45:

< inter-ideograph; MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 18pt; TEXT-ALIGN: justify">299, 1965

< inter-ideograph; MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; TEXT-ALIGN: justify">4-   Breuing K, Erikson E, Liu P, Miller DR. Healing of partial thickness porcine skin wounds in a liquid environment. J Surg Research.

< 0cm 280.9pt 0pt 6pt; TEXT-INDENT: 18pt; LINE-HEIGHT: 11pt">52: 50,1992 5-Svensjo T, Pomahac B, Yao F, Slama J, et al. Accelerated healing of full-thickness skin wounds in a wet environment. Plast Reconstr Surg 106: 602, 2000 6-Dyson M, Young S, Pendle L, Webster DF, et al. Comparison of the effects of moist and dry conditions on dermal repair. J Invest

< inter-ideograph; MARGIN: 0cm 0cm 0pt 18pt; LINE-HEIGHT: 11pt; TEXT-ALIGN: justify">Dermatol 91: 434, 1988

< inter-ideograph; MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; TEXT-ALIGN: justify">7-   Vogt PM, Andree C, Breuing K, Liu PY, et al. Dry, moist, and wet skin wound repair. Ann Plast Surg 34: 493, 1995

< inter-ideograph; MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; TEXT-ALIGN: justify">8-   Jonkman MF. Epidermal wound healing between moist and dry. Thesis, University of Groningen, Groningen, 1989

9-   Jonkman MF, Hoeksma EA, Nieuwenhuis P. Accelerated epithelialization under a highly vapor-permeable wound dressing is associated with increased precipitation of fibrin(ogen) and fibronectin. J Invest Dermatology 94: 477, 1990

10-Zawacki BE. Reversal of capillary stasis and prevention of necrosis in burns. Ann Plast Surg 180: 90, 1974

11-Atiyeh BS, Ioannovich J, Al-Amm CA, A. El-Musa KA. Management Of Acute And Chronic Open Wounds: The Importance Of Moist Environment In Optimal Wound Healing. Current Pharmaceutical Biotechnology 3: 179, 2002

12-Wortzman MS. Evaluation of mild skin cleansers. Dermatol Clin 9: 35, 1991

13-Winter GD, Scales JT: Effect of air drying and dressings on the surface of a wound. Nature 197: 91, 1963

14-Bolton LL, Monte K, Pirone LA. Moisture and healing: beyond the jargon. Ostomy Wound Manage 46(1A Suppl): 51S, 2000

15-Feldman L: Which dressing for split-thickness skin graft donor sites? Ann Plast Surg 27: 288, 1991

16-Nemeth AJ: Faster healing and less pain in skin biopsy sites treated with an occlusive dressing. Arch Dermatol 127: 1679, 1991

17-Willis I. The effects of prolonged water exposure on human skin. J Invest Dermatol 60: 166, 1973

18-Ehrlich HP. Fetal wound healing: A biochemical study of scarless healing. Plast Reconstr Surg 85: 495, 1990

19-Atiyeh BS, Ioannovich J, Al-Amm CA. Pansements de Sites Donneurs de Greffe de Peau Mince: Resultats Preliminaires D'une Etude Clinique Limitee Comparative de "MEBO" et de "Sofra-Tulle". Brûlures, Rev Franç Brûlologie 1: 155, 2000

20-Atiyeh BS, Al-Amm CA, Nasser AA. Improved Healing of Split Thickness skin Graft Donor Sites. J Applied Research 2: 114, 2002

21-Xu R: the medicine of burns and ulcers, a general introduction. Chinese J Burns Wounds Surf Ulcers 1 (1): 68, 1989

22-Wang GS, Zhang YM, Liu RS, et al.: Experimental study of the Effect of MEBO on blood rheology in the treatmet of burned rabbits. Chinese J Burns Wounds Surf Ulcers 5 (4): 30, 1993

23-Qu YY, Wang YP, Qiu SC et al.: Experimental research on the anti-infective mechanism of MEBO. Chinese J Burns Wounds Surf Ulcers 8 (1): 19, 1996

24-Xing D: Experimental study on the actions of the moist burn ointment on promoting healing of skin wound and anti-infection.  Chinese J Burns Wounds Surf Ulcers 1 (1): 75, 1989

25-Geng XL, Bu XC, Gao FQ, Liu YL: Study on the bacterial count in the subeschar living tissues of burn wounds Chinese J Burns Wounds Surf Ulcers 1 (1): 49, 1989

26-Huang QS, Zhou G, Su BP, Huang EX: A comparative study of fibronectin and MEBO in the treatment of experimental rabbit corneal alkaline burn. Chinese J Burns Wounds Surf Ulcers 7 (1): 18, 1995

27-Atiyeh BS, Ioannovich J, Magliacani G, Masellis M, Costagliola M, Dham R, Al-Musa K A. A new approach to local burn wound care: moist exposed therapy. a multiphase, multicenter study. J Burns & Surg Wound Care [serial online] 2:18, 2003. Available from: URL: http://www.journalofburns.com

28-Ioannovich J, Tsati E, Tsoutsos D, Frangia K, et al. Moist exposed burn therapy: evaluation of the epithelial repair process (an experimental model). Ann Burns Fire Disast 8: 3, 2000

29-Atiyeh BS, Ghanimeh G, Kaddoura IL, Al Amm C, Ioannovich J. Split thickness skin graft donor site dressing: preliminary results of controlled clinical comparative study of MEBO and sofra-tulle. Letter-to-the-editor. Ann Plast Surg 46: 88, 2001

30-Atiyeh BS, Al-Amm CA, El-Musa KA, Sawwaf A, Dham R. Scar quality and physiologic barrier function restoration following moist and moist exposed dressings of partial thickness wounds. Dematol Surg 29: 14, 2003

31-Atiyeh BS, Al-Amm CA, El-Musa KA, Sawwaf A, Dham R. The effect of moist and moist exposed dressings on healing and barrier function restoration of partial thickness wounds. Eur J Plast Surg 26: 5, 2003

32-Atiyeh BS, Amm CA, El Musa KA. Improved scar quality following primary and secondary healing of cutaneous wounds. Aesth Plast Surg 27: (in press), 2003

33-Atiyeh BS, Ioannovich J, Magliacani G, Masellis M, Costagliola M, Dham R. The Efficacy Of Moisture Retentive Ointment In The Mangement Of Cutaneous Wounds And Ulcers: A Multicenter Clinical Trial. Indian J Plast Surg 36: 89, 2003

34-Atiyeh BS, Ioannovich J, Magliacani G, Masellis M, Costagliola M, Dham R. The efficacy of MEBO (moist exposed burn ointment) in the management of cutaneous wounds and ulcers: a pilot study. Letter-to-the-editor, Ann Plast Surg 48: 226, 2002

35-Mostow EN. Wound healing: A multidisciplinary approach for dermatologists. Dermatol Clin 21: 371, 2003

36-Lionelli GT, Lawrence WT. Wound dressings. Surg Clin North Am 83: 617, 2003

37-Atiyeh BS, Hayek SN. An Update On Management Of Acute And Chronic Open Wounds: The Importance Of Moist Environment

In Optimal Wound Healing. Medicinal Chemistry Reviews – Online 1: (in press), 2004 38-Pearson AS, Wolford RW. Management of skin trauma. Dermatology 27: 475, 2000 39-Brem H, Nierman DM, Nelson JE. Pressure ulcers in the chronically critically ill patient. Critical Care Clin 18: 683, 2002
 楼主| 星月 发表于 2005-10-16 15:01:00 | 显示全部楼层
<>Figures below


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<>Fig. 1: Secondary healing of STSG donor site with MEBO, Sofra-Tulle, and Tegaderm. Better quality scar is observed with MEBO


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<>Fig. 2: Primarily healed scar over face treated prophylactically with MEBO. Rapid scar maturation is observed with good scar quality.



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<>Fig. 3: Secondary healing of wound dehiscence with MEBO. Rapid progression of Healing
Index


[此贴子已经被作者于2005-10-16 15:09:28编辑过]
冷月心炉 发表于 2005-10-15 18:11:00 | 显示全部楼层
一点质疑---------与星月商榷
< align=left>   < align=left>.  佩服你对P病的钻研及用心。只是一点疑惑,随着你在论坛连篇累牍的发帖频率与数量而与日俱增。对于你推崇备至的美宝湿润烧伤膏,因为没有使用过,老实说也一直没有时间精力仔细看你的帖子,也更无法知道你强力推荐的美宝湿润烧伤膏的真正成分还有什么,所以今天不想在该药的药理药效上多发表评论。我的质疑是价格上的——问过一个用过的P友,她说一合药的市售价格是25元左右,你的指导是一天需要用3到4合或更多,那一天下来的费用真是够受的。如果物有所值倒也罢了,但从公布的药物主要成分来看,类似于我知道的三黄膏、普连膏之类的。(大凡非西药的烧伤膏,无非就是这些有消炎解毒的中药加凡士林、植物油的调和)。这类药我几年前也试用过,没有在我的系列帖子里提到就说明于我无效。记得当时在医院开的也就2元左右一合吧(20克),今天我去向搞中药制剂的同行打听,即使是现在它们的成本价格也只应该是你推荐的美宝湿润烧伤膏十分之一,至多也是N分之一罢了。当然你也许可能会说它里面还含有什么低分子甚至纳米技术什么的,但据对烧伤的治疗原理,好象还犯不上要弄这些玄虚吧?而且作为只是该产品使用者的身份,谁能保证它里面到底会有哪些该有的或是不该有的成分呢?

< align=left>   烧伤患者的体表烧伤面积一般是很难达到P病灶面积之广泛的。果若如此,该烧伤患者早就会有生命之虞,早该启动全方位抢救治疗方案了,可以肯定不会以烧伤膏作为主要治疗手段的。所以,该含量秀气、价格不菲的烧伤膏作为小面积的烧伤使用,尚可勉强接受。但如果用于往往是全身泛发的P友身上,则未免有“钱袋不能承受之重”了罢?何况疗程......? 如此较高消费的、不管怎么说也是用于烧伤为主的药物,在向P友们大力推荐时,是否也应该考虑一下P友的经济代价?

   顺便说一句:据上面提到的那位用过此药的P友说,她在你的指导下用药后,开始效果不错,皮疹比较快就退下去了,但后来又复发,再用效果就差多了,他于是也没有坚持用下去了。从这个用药规律来看,此药里倒像是不能排除含有……?(幸好是外用药,即使含有点什么也还是说的过去的). 不过既然你也不是生产者,也不一定清楚,我就不问了罢。

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< align=left>   偶然看到你一篇帖子里,你提到使用美宝湿润烧伤膏后你夫人鼻头上的黑点没有了,面部皮肤也光洁了,刚才瞄了一眼你新发的帖子,你索性用上了“当化妆品来使:)”的字样,我个人感觉有神话夸大此药之嫌。 <>

<>

<>   当然外用药,尤其是纯粹的中药外用药在治疗上还是安全的。还有比如在F+X、松膏、黑豆溜油等基础上的加减创新都是可行的。即使你推荐的这个烧伤膏,其用于烧伤肌肤的某些作用机理,如消炎、保湿、油性滋润等方面对于P也是可能起到辅助治疗作用的。作为个人经验的介绍、让有兴趣的P友尝试并没有什么不可以的。我要说的是:在“P有很多对症治疗方法,但没有一种方法对每一个人都有效,更没有根治的方法”这一理念已经得到国际上公认的前提下,就不应该如此花大力气宣传推荐某种药物,尤其是治疗费用又较大且疗效并不肯定的药物。作为P患的家属,我以为在推荐药物时,更当理解患者的生活质量已经囿于疾病原因而有所降低,则更应体现人文关怀,做全方位的考虑。至少应该说明一下价格问题。 <>

   以你对美宝湿润烧伤膏投入的巨大热情,我知道你会花上大力气来回帖的,我甚至能猜测到你会怎么说。有言在先:本人实在堪称与人为善的人。不会存心损害任何人的利益,而且最不愿把时间精力放在无谓的争执上。只有在顾及多数人的利益时本人才会天性流露。可能有得罪之处,对不起了。在有关P的治疗上,我自认为我已经在我的系列里(之二、之六)说的很清楚了。我的性情是不喜欢重复罗嗦的,所以在治疗交流方面我后来就不再随便发言。但凡说出来的话都是经过考虑权衡,是负责任的,所以不怕辩驳。不过我没有时间耐性拉锯似的你来我往争论不休,所以事先说明可能不做回应就以此帖为准了,对与否,由阅帖者自行判断吧。

   一直喜欢这句话——心底无私天地宽。愿与星月共勉。

   最后诚祝你夫人早日康复

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