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The Efficacy Analysis of MEBO Scar Ointment in Treating Hypertrophic Scar Tested by B Ultrasound
Author£ºAdmin  
Source:mebo
Add Time£º2011/2/23 13:27:46
Hits£º3885

LIU Wan-hui£¬LIU Shan-wu£¬SUN Bin£¬et al.
Boshan Burn and Plastic Hospital£¬Zibo£¬Shandong province£¬255200£¬China.
¡¾Abstract¡¿ Objective£ºThe thickness of hypertrophic scar and the adhesive partnership between hypertrophic scar and surround tissues were tested by B Ultrasound in order to establish an objective and non-invasive method evaluating the therapeutic effect, and investigate the therapeutic effect in the treatment of hypertrophic scar with the association of multiple therapies. Method£º140 cases with hypertrophic scar in line with the criteria were chosen as the test group; another 20 cases that treated only with pressure therapy and other 30 cases that treated with pressure in association with interferon injection were combined as the control group. Results£º in treatment group£¬120 cases gained remarkable effects£¬20 cases had effects and no case was ineffective. The total effective rate was 100%. In the control group, the time to obtain the results of markedly effects and effects was 3 months later than that in test group which treated with MEBO Scar Lotion in association with pressure therapy and interferon injection. Conclusion£ºThe results of the examination of B Ultrasound showed that the thickness of hypertrophic scar and the adhesive partnership between hypertrophic scar and surround tissues had been noticeably improved with the application of MEBO Scareducer in the entire treating process. Besides, the patients felt comfort with apparent improvement of their joint function.
¡¾Key words¡¿ Hypertrophic scar£»MEBO Scareducer£»Examination of B ultrasound£»Pressure therapy£»Interferon
 
One of the important mechanisms of the formation of hypertrophic scar is that the fibroblasts can not enter the procedures of normal apoptosis that causes the abnormal proliferation of fibroblasts. Then it leads to the over-excessive deposition of extracellular matrix components. The scar will be produced during the process of wound healing. But the over-excessive growth of formed scar will lead to various kinds of complications, such as physical disfigurement, limited mobility, malfunction of the affected area and etc. Thereby, the prevention and treatment of hypertrophic scar is one of priority assignments during the last phase of burn treatment. The treatments to hypertrophic scar are classified into three groups: non-surgical therapy, surgical therapy and comprehensive therapy. The non-surgical treatment is easy to be accepted by most clients for its non-invasive and painless. In my department, good results were gained in the treatment of hundreds of clients with hypertrophic scar with the application of MEBO Scareducer. As there is no breakthrough in the basic studies of scar and no mature therapeutic program in prevent and treatment of scar, the therapeutic program of hypertrophic scar in my department is to imbed the prevention into the treatment of scar. The main key-points as followed£Û1£Ý: I. Positively promote the early healing of the wound; II. Positively carry out the therapeutic interventions within 1 or 2 years after the wound healing; III. Perform the regular follow-up and offer timely interventions. There are many ways to evaluate the treatment and the control of hypertrophic scar, the application of B ultrasound to detect the thickness change of hypertrophic scar in my department is an economic and convenient way with reliable effects. The results of B ultrasound, such as gray value analysis and the relevant picture data recorded can either provide the clinical physician the morphological data or be given the direct clinical evaluation.
 
1£® Clinical data
470 clients (male: 350 case, female: 120 cases) with hypertrophic scar were treated with the topical administration of MEBO Scareducer from the year of 2003 to 2009 by the author of this article. 140 of them that were in line with the observing criteria were constituted the test group; another 20 cases that treated only with pressure therapy and other 30 cases that treated with pressure in association with interferon injection were combined as the control group.
1.1. The criteria to screen the object: (1) all cases must be received the anti-scar therapy after the wound healing; (2) the sites of hypertrophic scar mainly locate extremities and trunk; (3) MEBO Scareducer should be applied in the entire course of treatment and the client must adhere to the instruction to use; (4) the surface area of hypertrophic scar should be higher than 5%; (5) Combined with pressure therapy or interferon injection; (6) conform to the regular follow-up.
1.2. Criteria for therapeutic effects: according to the improving degrees of clinical symptoms, three classifications can be grouped: remarkable effects, effects and no effects.
£¨1£©Remarkable effects: Complete maturity of hypertrophic scar, after depressurizing the scar area, there is no congestion with the color same as the surrounding normal skin, flattened and softened scar with elasticity and disappearance of itching and soreness.
£¨2£©Effects: the hypertrophic scar is still in immature; although the congestion is significantly reduced, the color does not yet turn normal; the raised scar is softened but with no elasticity and mild itching and pain. 
£¨3£©No effects: the degrees and symptoms of scar are the same as before.
1.3. Methods: Instruments: B ultrasound Doppler Diagnosing Instrument, type EUB-40 (Japan) and type SPECTRA (US) were applied with the frequencies of transducer: 5MHZ and 10MHZ. Procedures of examination: Place the client at proper position on the bed, then put the transducer that coated with couplant on the surface of hypertrophic scar and inspect. Criteria of the examination of B ultrasound: prior to the application of MEBO Scareducer, the thickness of hypertrophic scar was tested by B ultrasound, the adhesive partnership between hypertrophic scar and surrounding tissue was observed and the relevant pictures were measured by picture data recorders and documented once per one month. Then, compared the results.
The ways to use MEBO Scareducer: after the wound had healed, cleansed the affected area and then evenly smeared MEBO Scareducer on the hypertrophic scar tissue with the dose same as the other emollients. Meanwhile, the affected area should be massaged for 5 to 10 minutes with fingers (the strength should be appropriate, not up to the appearance of blister) to promote the absorption of MEBO Scareducer. Later, pressure therapy was associated. All cases were intramuscularly administered Interferon 3 million IU (or 5 million IU) QOD or twice per week. The mechanisms are to suppress the proliferation of fibroblasts, suppress the production of prolyl hydroxylase that needs in the course of collagen synthesis, stop the production of collagen and decompose the collagen. MEBO Scareducer is used form 3 to 4 times per day. The shortest course of treatment is 6 months, the longest is 20 months. 
1.4. Results: 120 cases gained remarkable effects:, 20 cases gained effects; there is no ineffective case. The total effective rate is 100%. In the control group, the time to obtain the results of markedly effects and effects was 3 months later than that in test group which treated with MEBO Scar Lotion in association with pressure therapy and interferon injection. And in test group, no skin allergic reaction occurred that explicitly showed the superiority of natural botanical components of MEBO Scareducer and the good skin adaptability.


2. Discussion
The treatment of scar is either a long-term process with complication or an important assignment in the trauma rehabilitation that the key is to observe the continuous therapy after the wound healing and to see if the hypertrophic scar could be effectively controlled and the occurrence of deformity could be extremely prevented. At the same time, it also needs to get the multiple co-operations from client, families, health care provider and etc. The treatments of scar can be divided into non-surgical therapy and surgical therapy. At present, although there are many non-surgical therapies, the hypertrophy and contracture of scar can not yet effectively controlled on most clients, in particular for those with large and deep burn areas. Therefore, it always relies on surgical ways on individual case whose severe hypertrophy and contracture of scar cause the cosmetic problems and joint malfunction. There are many ways to perform the scar plasty, but there is not one definite way to define the layer analysis of the scar thickness and the existence of scar tissue as well as the adhesive extent with surrounding tissues. The writer of this article has paid concerns on the clinical studies of scar for many years to try to find a definite way to accurately define the thickness of scar tissue and the anatomic relationship and the adhesive extents between the scar and its surrounding tissue, especially the deep tissues with a hope that provides the theoretical and morphological evidence for clinical physicians and improves the clnical efficacy of plastic operations. The B ultrasonograpy is an economic, accurate, convenient and painless way that is more susceptible to be accepted by clients. And it can directly display the picture of soft tissue, tendon and bone with high rate of diagnostic accuracy and the provision of reliable picture data. However, the surface of scar is uneven that can impact the results. Despite of the remedial measures we adapted, the testing results were sometimes influenced. The extensive improvements and studies need to be done.
As for the evaluation criteria of therapeutic effects, Leung£Û2£Ý used several indicators such as the color, elasticity, texture and thickness of hypertrophic scar to the classifications. According to the color, it can be grouped into mild redness, pink, redness, purple and purplish red. In accordance with elasticity, it can be divided into very soft, softness, mild hardness, hardness, stiffness. In line with the thickness, it is classified as very thin, thin, mild thickness, thickness and apparent thickness. To combine the above three indicators, the severity of hypertrophic scar is classified. The assessment of each indicator depends on the inspection and the comparison. The elasticity can be measured by elastometer. The criteria adopted is the one proposed by Tang Xiaoxi £Û3£Ý. We thought that this criterion was comparatively standard and convenient for the clinical reference.
The combination of surgical way and non-surgical way is called comprehensive therapy that is the common way and the overall direction in the treatment of scar. And to find a comprehensive therapy with economy and effectiveness is beneficiary for clients. Pressure therapy: after the wound healing, timely apply pressure garment to bandage and the splint to maintain the affected joints in alignment that will effectively reduce the hypertrophy and contracture of scar tissue. The therapeutic effect of pressure therapy is definite. But, it still has some restraints. Some sites are hard to be applied. To administer bioactive agents, such as interferon, one agent widely used on patient with fibrosis disorders. It has three types: IFN-a¡¢IFN-¦Âand IFN-r. The mechanisms of interferon are to suppress the proliferation of fibroblasts, suppress the production of prolyl hydroxylase that needs in the course of collagen synthesis, stop the production of collagen and decompose the collagen. It can be thought that the application of interferon injection is a good compliment to the application of pressure therapy, especially the superiority in the prevention and treatment of hypertrophic scar on patients with large area burn injuries. The extracted pure natural botanical components in MEBO Scareducer can suppress the proliferation of fibroblasts, restore the normal tissue architecture and physiological function of skin, promote the regeneration of sebaceous glands and restore local physiological environment to attain the goal softening and repairing scar.
B ultrasonography is a good clinical diagnostic procedure in the assessment of hypertrophic scar. It can accurately examine the thickness of scar and the dimensional relationship with surrounding tissues, and then give the locative diagnosis. Meanwhile, the scar tissue can be examined from different directions without irradiation. Hence, it has significant meaning for the evaluation of the scar treatment. In my department, 470 cases with hypertrophic scar were treated with the application of MEBO Scareducer in association with pressure therapy and interferon injection. The effectiveness of 140 of them was traced by B ultrasonography. Good feedback were gained from the results of B ultrasonography. With the application of this comprehensive therapy, the patients were more susceptible to accept the interventions. It is convenient in the clinical extensive popularization for its reliable efficacy and economy.
 
Reference
 [1] Cai Jinglong, Zhang Zongxue  Science of Modern Scar Treatment £ÛM£Ý Beijing  People Health Press, 1998
 [2]Leung KS£¬et al (1989).Microcirculation in hypertrophic scar after burn injury£¬JBurn Care Rehabil£¬10£º436~444.
 [3] Tang Xiaoxi, Yang Liying, Shi Jixiang and et al (1994). Pressure Garment Used in the Treatment of Hypertrophic Scar Post-Burn £ÛJ£ÝChinese Journal of Plastic Surgery, 4£º267~269.


¡¾Author¡¯s Introduction¡¿
Liu Wanghui £¨1970~£©£¬Male£¨Han£©£¬from Jiamusi, Heilongjiang province£¬educated from the clinical medicine department of Jiamusi Medical College, vice-chief physician, director .
Liu Shanwu (1972~), Male (Han), from Zibo, Shandong province, educated from Shandong Chinese Medicine University, attending physician.
Sun Bing (1980-), Male (Han), from Zibo, Shandong province, educated from the clinical medicine department of Weifang Medical College, residency.


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