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Keynotes about Dressing-change on Wounds with In-situ Skin Regeneration Medical Technique
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Add Time£º2014/3/3 15:01:29
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Keynotes about Dressing-change on Wounds with In-situ Skin Regeneration Medical Technique
Liu Qiang with TCM Hospital of Tieling City, Liaoning Province
In recent years, we observed in our outpatient department or during our consultation with doctors from other hospitals that the treatment results enjoy close relation with standard operation of dressing change. Therefore, standardized dressing change shall be highly emphasized by clinical medical staff. In an effort to summarize the experiences gained in the dressing change for wounds with in-situ skin regeneration medical technique (MEBT), improve clinical efficacies and analyze the time, methods and other details about dressing change with MEBO, we obtained the following information, e.g. the dressing change shall be done as early and prompt as possible, the methods of dressing change shall be determined based on course of disease, area and location of burns, age and physical conditions of patients, the dressing change process shall be well protected by fiber isolation membrane and standardized dressing change technique can improve clinical efficacies.
Time of Dressing Change
 
In MEBT, the two key words for the time of dressing change are early and prompt. Usually, the best results can be observed no longer than 4 hours after injury in order to save stasis tissues on burnt wounds and prevent progressive necrosis and maintain the regeneration and restoration of wound tissues. The liquefactions on wounds shall be cleansed once every four hours, and the principle of ¡°Three Prompt¡± shall be followed, e.g. Prompt Cleansing of Liquefactions, Prompt Cleansing Necrotic Tissues and Prompt Administration. This is the point-of-view of Dr. Xu Rongxiang, the inventor of MEBO, this is the guide of dressing change of MEBT and the theoretical base for clinical practice. With regard to the application of the theory in clinical practice, the author believes that the dressing change time shall be strictly controlled for patients with burns. And the time of dressing change shall be flexibly controlled according to conditions of patients. Usually, it shall be determined based on the area and location of burns, conditions of wounds, physical conditions of patients and dressing change methods. Generally, dressing change time for exposed wounds in secretion phase shall be about 4 hours. The dressing change time for wounds at mid-term of burns or semi-exposed burns shall be about 6 to 8 hours, and 12 to 24 hours for wounds at reparation phase or bandaged wounds. It shall be determined by the conditions of secretion on wounds in order to realize physiological regeneration and restoration through ¡°Three No Principles¡±, e.g. maintaining moist environment on wounds and preventing soaking by secretions. Observation of wound secretions is an important factor in controlling dressing change time.
Methods of Dressing Change
Methods for dressing change shall be determined according to time of injury, area and location of burns, age of patients, conditions of wards and the patients. Usually, exposed treatment is suitable for patients with extensive burns and torso burns. However, such treatment would not be suitable for those patients with medium and small burns on four limbs, and semi-exposed or bandaging treatment would be fine. For children, bandaging treatment is often taken. No matter what method is followed, the principle of preventing soaking of wounds shall be strictly followed. In clinical practice, the change of wounds conditions shall be paid special attention. Once the secretion is found on wounds, dressing change shall be done timely in order to reduce the number of bacteria, the inflammatory media generated by necrotic tissues and absorption of toxins and improve wound healing. once the compressed bandaging method is taken, the indication and time of bandaging shall be selected. The bandaging method is mainly applicable on granulation wounds formed by partial-thickness deep type or full-thickness superficial type burns on four limbs and torso, the area is usually no more than 10%TBSA. The time for compressed bandaging method is usually the phase when scattered skin islands appear on wounds with less secretions and granulations. The dressing change shall focus on the following: the thickness of ointment shall be about 1mm to 2mm; the wound shall be cleansed with normal saline before being dried up with gauze; skin on edge of wounds shall be sterilized by bromogeramine or iodophor; no Vaseline gauze shall be used when bandaging, one layer of net gauze shall be used in interior layer and coating and cotton cushion is used on exterior layer; the bandaging shall be suitable with regard to compression to avoid any bandaging that might influence blood circulation. The main mechanism for the compressed bandaging treatment is t create sound moist environment on wounds. Suitable compression and relative closure can obviously speed up healing process. The mechanism is subject to further research.
 
The author believes that bandaging treatment can promote healing process of wounds with granulations. Judging from the re-establishing micro-circulation, the new blood vessels can be compressed flat with bandaging treatment, and new skin can easily climb and heal. However, such method changes the three-dimensional mechanism of healing for burn wounds and influences quality of skin after healing, which requires further discussion.
 
Notes in Dressing Change
 
With regard to operation without injuries, the ¡°Three No¡± principle shall be followed, e.g. no future bleeding, no further damaging normal tissues and no more pains. MEBT enjoys simple and complicated dressing change. First, the operation shall be carried out in a gentle manner when removing the necrotic tissues and secretions on wounds. Any violent operation shall be prohibited. Since the doctor might believe that they handle in a gentle way when they are contacting the wounds with tweezers and scissors. However, this might be extremely painful for patients. Therefore, medical staff shall try to understand what patients feel and their pains. In every dressing change, residual necrotic tissues, liquefactions and MEBO ointment on wounds shall be removed as much as possible. The normal tissues shall be maintained while the residuals shall be cleansed, which is the fundamental rule for dressing change. MEBO ointment shall be smeared after debridement in a smooth manner, without leaving wounds exposed.
 
The fiber isolation membrane shall be protected. The fiber isolation membrane on wounds is the lipoprotein combination formed by ester generated in the series of biochemical process and the plasma exudations discharged on wounds during liquefaction process of necrotic tissues due to the effect of MEBO. The membrane is closely sticking to the surface of wounds to maintain the moist environment of wounds and realize regeneration and restoration of wounds. The in-situ regeneration and restoration of skin is realized through the protection of fiber isolation membrane and standardized application of MEBT. Only under the circumstances that fiber isolation membrane exists, the micro-circulation structure deep inside the wounds can be regenerated in the form of capillary tree in order to maintain the nutrition supply by embryo base and skin island on original skin formed in the process of regeneration of in-situ stem cells and develop such stem cells for the healing of wounds. Therefore, fiber isolation membrane shall be well protected during debridement and dressing-change. Usually, two to three layers of fiber isolation membranes can be generated on partial-thickness or full-thickness wounds. During dressing-change, each layer of fiber isolation membrane shall naturally shed off. Some membranes are thick and some are thin, so, the existing time is usually about 1 week.
 
All in all, clinical medical staff shall be responsible for burn patients and shall pay attention to all details in dressing change, including time and methods. It is believed that dressing change shall be handled just like what surgeons do in operations. The operation shall be accurate and wounds shall be closely watched, and patients shall be well understood. Only by doing so, can the advantages of in-situ skin regeneration technology be given full play and wound infections be prevented and clinical efficacies be improved.
 

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