A Commentary on Burns Medical and Regenerative Therapy编辑：Rong Xiang Xu 出版社：KARGER 发行日期：In 2004
A Commentary on Burn Medical Therapy
Part 1: A COMMENTARY ON SURGICAL EXCISION AND SKIN-GRAFTING THERAPY
Burns therapy with surgical excision and skin grafting is a surgical technique in that it treats the burns wounds with a surgical method. Surgical technique, in essence, treats disease through a destructive means while prioritizing the survival of the patient about the importance of the appearance and function of the burned limb. Before BRT with MEBT/MEBO was invented, surgical burns therapy had become a major method of burns treatment. However, subsequent to the invention of burns regenerative medicine and therapy helpful comparisons have been made between both modalities. Impartial investigators have learned that deep second-degree burns wounds should no longer be treated with surgical therapy because burns regenerative medicine therapy is objectively superior to the surgical approach. One remaining indication for the use of surgical excision and skin grafting for the treatment of burns may involve third-degree burns with surviving subcutaneous tissues. This, however, must only be done after prudent consideration. The indication of surgical burns therapy should now be defined as: severe large-area burns reaching the lower layer of superficial fascia. Surgical burns therapy should no longer be the major method of burns treatment.
This book also introduces the latest technique of skin grafting using cultured composite autografts after surgical excision. This new technique aims at overcoming the difficulty of the incorporation of the cultured epithelial autograft into the burns wound. This technique can effectively prevent “autograft exfoliation” and secondary ulceration. The doctors of the laboratory of Culture Technology, Inc., Sherman Oaks, Calif., USA, harvested two components of the skin, autologous keratinocytes and fibroblasts from burns patients and cultured them to enhance proliferation, and then combined them to form epidermal and dermal matrix. Once grown to confluence, the composite autografts are ready for application to the burn wound. These results were published in BURNS 1999; 25; 771-779. This technique had been successfully applied in the treatment of large-area burns after surgical excision in the Burn Centre in Arizona State. While this is a significant step forward, we must acknowledge that its treating principle is the same as that of surgical burns therapy. It protects the autograft but cannot avoid the damage or disablement caused by excision. Another comparable disadvantage to this technique is its expense. Therefore, indication for this technique should be third-degree burns and burns in the muscle layer. This skin grafting using cultured composite autografts after surgical excision should not be considered a major method of burns treatment.
Part 2: A COMMENTARY ON MOIST-EXPOSED BURNS THERAPY
BRT with MEBT/MEBO is a comprehensive therapeutic technique aiming at treating burns tissue in compliance with the law of burns pathogenesis. Compared with surgical burns therapy, BRT with MEBT/MEBO is a technique treating the burns wound in the skin, while surgical burns therapy is a technique treating wounds in the muscle. Together, these two approaches, when used appropriately, form a complementary therapeutic system. BRT with MEBT/MEBO can be applied for the treatment of skin burns while surgical burns therapy can be best applied to the treatment of muscle burns. Briefly, BRT with MEBT/MEBO offers unique therapeutic breakthroughs in treating skin burns as follows:
A) BRT with MEBT/MEBO removes the necrotic skin without causing any damage. Removal of necrotic skin layer is the first step of burns treatment. Doctors found no way to remove the necrotic tissue during the past century, except the destructive method which cut away the injured wound tissue together with the surrounding surviving tissues and results in further traumatic injuries. Taking the advantages of the relevant biochemical principles, BRT with MEBT/MEBO can spontaneously remove the necrotic tissue through liquefaction and drainage without causing further injury to the surrounding surviving tissue. It alone has successfully resolved this difficult problem.
B) BRT with MEBT/MEBO preserves the surviving tissue to the greatest extent currently possible. Burns wound surface is not smooth and a surgical knife cannot distinguish between injured tissue and surviving tissue. Surgeons always excise the surviving tissue together with dead tissue and this is a very serious attack on the patient – at times it can be more serious than burns injury itself. Moreover, after excision, the body surface typically never recovers the loss of subcutaneous surviving tissue. However, studies demonstrate that, if not excised, this recovery can occur. BRT with MEBT/MEBO takes advantage of the frame structure of the nutritive base of the drug and the principle of biochemistry therewith successfully preserving the surviving tissue.
C) BRT with MEBT/MEBO demonstrates that the dream of skin regeneration has come true. For about a century, scientists made great efforts to achieve the regeneration of injured skin. In the early 20th century, doctors discovered that the subcutaneous tissues survive after full thickness third-degree burns and may be capable of regeneration. However, they did not find an adequate measure to achieve this survival and therefore they pursued research on in vitro skin cell culture and transplantation of the cultured autograft. By utilizing the regeneration gene for skin information in the subcutaneous tissue, in concert with the creation of a favorable nurturing environment (one favorable to physiological regeneration of the skin), BRT with MEBT/MEBO successfully achieves the skin regeneration within large areas of deep burns wounds. This achievement greatly decreased the disablement rate, and increased the survival rate of large-area burns by 50~80% (compared with the data published in 1997 and 1994).
D) BRT with MEBT/MEBO resolves the problem of pain in second-degree burns patients. As any person who has cared for burns patients knows all too well, burns wound pain is the worst aspect of the suffering of superficial burns patients. Surgical treatment aims at saving the life without considering the problem of pain. Surgical operations typically make the pain more serious and many patients with large-area superficial burns die because their cases worsen after operation. Severe pain causes shock and wound stress regulation disturbance which can tip the scales toward multiple system organ failure and death. That is why large-area as well as small-area burns are described as life-threatening in the burns care textbooks. Pain remains one of the main causes of burns-related death in all countries. BRT with MEBT/MEBO takes the advantage of the drug MEBO with a unique frame structure base to eliminate pain almost immediately upon application. MEBO covers the wound surface, protects the wound from irritations and relieves the pain. This unique effect of MEBO finally resolved the problem of burns wound pain.
E) BRT with MEBT/MEBO opens up a new approach to the prevention and treatment of infection. Local and systemic infection is a difficult problem of burns treatment and today in the era of multidrug resistant pathogens, we are scarcely further ahead than we were years ago. Many antibiotics have been applied but the efficacy proves unsatisfactory. BRT with MEBT/MEBO resolves this problem by treating the local area in compliance with the pathogenesis of the infection of burns wound. This treatment controls infection of burns wound by changing the ecological environment. Concurrently, by applying BRT with MEBT/MEBO to the large-area burns, in accordance with the law of systematic pathogenesis of infections, we discover that BRT with MEBT/MEBO is capable of mobilizing and coordinating the potential physiological energy of the systemic wound stress reaction. This alone has successfully advanced a systematic anti-infection principle for treating large-area burns. To be more specific: At the shock stage, when wound stress reaction is on the upsurge, we recommend the systemic application of broad spectrum antibiotics with no adverse effect on the kidney. After this stage, when synthetic metabolism of protein begins, we recommend that one stop the application of any antibiotics. In the whole course of treatment, if systemic infection occurs occasionally, a single large dose of broad-spectrum antibiotic (one with no side effects on kidney) is applied. In this fashion, BRT with MEBT/MEBO offers a systematic scheme for removing the focus of infection and minimizes the dependence upon antibiotics.
F) BRT with MEBT/MEBO allows one to create a new antishock scheme. It is a common understanding that shock is a serious disease of burns. For a long time, no matter what treating method is adopted, the same standardized fluid infusion antishock scheme is applied. BRT with MEBT/MEBO considers that there should be different antishock schemes for different treating methods and different cases. Surgical operation always makes shock more serious and therefore, fluid infused to replenish the blood volume is of paramount importance. Remarkably, BRT with MEBT/MEBO does not produce any new injury. On the contrary, it helps to develop spontaneous resuscitation. Antishock measures mainly aim at protecting and strengthening the cardiac and renal function. Blood volume replenishment is required only according the principle of general traumatic surgery. Shock, the greatest killer of burns patients, is finally tamed.
G) BRT with MEBT/MEBO relieves the economic and mental load of the burns victims. Textbooks overemphasize that surgical operation is the only method for treating burns, so people are frightened of the sufferings during the operation and the high cost of the treatment. In the US, it typically costs a burns patient $150,000 USD to be treated in the hospital and this does not include the expense of subsequent plastic surgery. Because surgical operation requires strictly sterile and isolated wards, such wards are very expensive to build and maintain. In western countries, treating burns victims with burns area over 50% BSA is considered to have no economic value, because most of the patients will become disabled. BRT with MEBT/MEBO is very revolutionary in this matter as it does not require strictly sterile conditions nor does it require isolation. On the contrary, large-area burns patients can be treated in ordinary hospital wards or even in battlefield hospitals and they will recover to become healthy and normal people. The cost is extremely low by comparison and small-area burns patients, if treated with BRT with MEBT/MEBO, do not require hospitalization.
BRT with MEBT/MEBO can cure burns of different causes and different areas, including superficial second-degree, deep second-degree, full thickness third-degree burns. It is also an ideal technique for granulation tissue regeneration and repair of burns in muscular layer and bone. BRT with MEBT/MEBO is the major method of burns treatment.
To sum up, what is described above is not speculation. This is clinically demonstrated and despite the skepticism of the reader, responsible investigation into these claims will convince all that burns therapy has now developed into a new historic stage. In the past, only surgical excision and skin grafting method were the standard of care and offered great benefit to those whose lives were threatened. Today, however, with the invention of BRT with MEBT/MEBO a major method for burns treatment is available. Either alone or in combination with surgical care, we now offer an elevation in the standard of care for the treatment of burns. As we move together into the 21st century, burns therapy will continue to develop along the lines of BRT with MEBT/MEBO.