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Therapeutics Focus

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

Burn regenerative medicine and therapy refers to the medical management up to the complex pathogenesis of burns. Emphasis in this volume is made on the therapeutics focus of local burns wound, an especially conclusive description. Considering the management of the burns wound environment, two techniques are currently available worldwide for local burns treatment. One option is based upon the perceived benefit of maintaining the wound in a dry and dehydrated state while the other strives to maintain the wound in a physiologically moist state. Research clearly demonstrates that the former compromises while the latter encourages tissue regeneration. Simply stated, one is pathological and the other physiological as regards tissue repair. In clinical treatment, careful consideration is needed for choosing the appropriate burn therapy according to the depth of the burns wound. For superficial burns, as long as pain is relieved and further injury is prevented, any burn therapy may achieve successful results. For deep second-degree and/or third-degree burns, the choice of therapy is more critical since pathological healing may result in disablility and lifelong distress for the patients.

Due to differences of cultures and academic ideologies in the medical circles, two categories of burn therapy predominate in treating deep burns wounds. These are: (1) “surgical excision and skin grafting therapy” and (2) “conservative repairing therapy (burn regenerative medicine and therapy)”. The former is symbolized by the therapy established in the 1930s, with the characteristic of excision and skin grafting (a variety of autografts) for wound closure. As the main stream in the western medical circles, this therapy has been adopted in hospitals all over the world. The latter, burns regenerative medicine and therapy, involves two modalities: moist-exposed burns treatment (MEBT) and moist-exposed burn ointment (MEBO). This innovative and impressive modality was established by Dr. Rongxiang Xu in the late 20th century. It features the discharge of necrotic tissues by liquefaction in a manner that does not cause further secondary injury and also supports the establishment of a physiological environment sufficient to repair residual viable tissues while regenerating skin tissue. This therapy has been successfully exported to 48 countries and enjoys wide clinical application while attaining the predominant status for burns care in eastern medical circles. Herein to follow are the main points of the two categories of the burn therapies.

1. Therapeutics focus of surgical excision and skin grafting therapy: Surgical excision and skin grafting therapy is established upon the premise that no effective method is available for treating a series of postburn illness. It is considered that the tissues in the zone of stasis of deep second-degree burns is doomed to a complicated and dangerous progressive necrosis. Additionally, it is assumed that wound with necrosis of full thickness dermis is unlikely to heal spontaneously. During the procedure of conservative repairing treatment for deep burn wounds, infection, inflammation and other serious complications may develop and become life threatening, and the treatment result will be pathological. Based upon the above consideration, a therapy was established: First transform the burns wound to a traumatic wound via surgical intervention and then perform the conventional burns treatment in an attempt to increase survival rate. In the clinic setting, the whole burned necrotic tissue together with some viable dermis or subcutaneous tissue are removed, creating a surgical wound of muscle layer over which a variety of autografts are placed to close the wound. Admittedly, this therapeutic option anticipates a compromised and suboptimal result while striving mostly to save the patient’s life. This therapy is a purely surgical technique and functions with disregard to burns physiology. As a treatment, it resembles the treatment of a gastric ulcer by surgical intervention - subtotal gastrectomy. Therefore, this therapy does not treat burn tissue itself but constitutes simply a surgical therapy for treating muscle or deeper burns rather than skin burns.

2. Therapeutics Focus of Burn Regenerative Therapy (MEBT/MEBO): MEBT was invented on the basis of a series of burns natural pathogeneses, appreciating each aspects of burns tissue’s physiological response including physical, chemical and biochemical reactions. Additionally, it incorporates an understanding of necrotic tissue rejection as well as principles of physiological repair and regeneration. The main therapeutic focus is manifested in the following aspects:

(1) alleviation of wound pain by microprotection of injured nerve ending and by relief of hair arrectores pilorum spasm;

(2) prevention or resolution of continuous physical thermal injury by the application of an ointment which draws away the residual heat from the wound through a specially designed frame structure dosage;

(3) discharge of necrotic tissues by liquefaction without causing further secondary injury while allowing the residual viable tissues to continue an endogenous process of regeneration;

(4) creation of a physiologically moist environment to ensure the physiological repairing of residual skin tissues;

(5) realization of skin regeneration in compliance with the principles of endogenous histological and cytological regeneration;

(6) control of microbial concentration and toxicity at the wound site so as to prevent and control pathogenic infection through continuous active drainage of the wound as well as by other mechanisms;

(7) regulation the physiological repairing of burns wounds with the comprehensive active ingredients of the MEBO ointment.

Burn regenerative medicine and therapy (MEBT/MEBO) was established in the context of a worldwide concensus that that surgical burns therapy comprised a suboptimal therapy. It arose in a therapeutic vacuum where no substantial innovations had been offered for modern burns treatment. MEBT/MEBO has basically realized the treatment of burns tissue itself, and become the mainstream medical therapy for skin burns. However, even MEBT/MEBO has its limitations, for presently it also is not suitable for treating burns involving muscle or deeper layers. Unfortunately, current research has made no progress in regenerating new skin from muscle tissue. For burns with a diameter less than 20 cm involving the muscle layer, the wound may heal with MEBT/MEBO by the migrating of epithelial cells from the wound margin transversely to regenerate skin and then close the wound. With the assistance of a surgical technique, electric burns and local burns involving bones may be treated with satisfactory results (data attached below). Happily,  burns replacement therapy offers a breakthrough therapeutic benefit in that it may enable larger muscle layer burns to heal spontaneously.

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