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The Clinical Experience to Use MEBT/MEBO in Treating Keloid
Add Time2011/5/24 17:06:22
Wang Xiang-ning  Yang Zheng-bing  Xiong Hao  Zhang Ling  Fu Zi-jun
(Yaan Peoples Hospital   Sichuan Provence   625000)
 [Abstract] Objective: To observe the clinical therapeutic effects of using MEBT/MEBO in treating keloid. Method: After removal of keloid, use bandage therapy of MEBT/MEBO in the whole course of treatment. Results: All wounds were healed with superficial or soft scars. Conclusion: Procedures of MEBT/MEBO in treating keloid are simple and micro-invasive. The therapeutic effect is significantly apparent.
[Key-words] MEBT/MEBO; Keloid; Treatment  
Since the use of MEBT/MEBO in our unit, we always pay our attentions to collect the medical data of keloid treatment. In the past, the treatment of keloid was to use rotation flap and combine the radiation therapy after flap. But this way causes large impairment and often leaves bigger scar. The recurrent rate of applying this traditional way is also high. It has been concluded that MEBT/MEBO is a micro-invasive, simple way in the treatment of patients with keloid who was admitted from 2007 to March of 2010 in our unit. After the wound healing, affected skin lesions could be turned into superficial scar or soft scar in combination with scar therapy of MEBT/MEBO. Now the conclusion as followed: 
I.              Clinical material
Totally 80 patients (45 males, 35 females) with keloid were treated. Their ages are between 16 and 72 years old. Their medical history is about 10 years. The affected areas mainly locate on extremities (most), chest wall, abdomen and back. The patients often complained of different degrees of pruritus. The keloid were inspected elevated, hardness, unfair surface, wrinkled, hollowed with the color of redness and dark brown.  
II.            Intervention:
i. Perform blood examinations: Complete Blood Count, PT and APPT. Female avoid the examinations during the menstrual periods.
ii. Never sterilize and bandage the keloid prior to the procedure of keloid excision. But it needs to clean the keloid up, in particular the hollowed space that accommodates the contaminations.
iii. After the performance of local infiltration anesthesia (generally the range of anesthesia is 1 to 2cm wider than the base of keloid; a little massif higher than the surrounding normal skin will be formed), use Humbys knife to peel the scarring tissue off layer by layer, not to excise beyond the boundary between keloid and normal tissue or to at least impair the normal tissue.  
iv. The excised scarring tissue should be sent to the pathological unit to determine its quality.
v. Smear MEBO Wound Ointment on the surgical site after the removal of keloid at 2 to 3mm film, and then cover with MEBO gauze and sterile gazue, wrap up with elastic bandage; do not change the dressing at the first day after operation; open the dressing at the second day after operation, remove the remnant ointment and the dried bloodstain can be left; after that, top up sufficient amount of MEBO Wound Ointment and wrap up with elastic bandage (the thickness of bandage should be more than surrounding tissue in purpose to exert the proper pressure on the surgical site). Generally, 7 to 10 days after dressing-change, the dried bloodstain will be automatically liquefied and discharged with the growth of granulation tissue; at this time, MEBO Dressing can be used once per day. But prior to administration of MEBO Dressing, a thin layer of MEBO Wound Ointment should be topped up to avoid the dryness of wound bed. Keep on the dressing-change until the wound healing.
iv. After the wound healing, microwave can be chosen to treat the scar for the ones with the microwave instruments available. For the ones without microwave therapy, MEBO Wound Ointment should be used on wound bed continuously for about 15 days, and then start the scar therapy. But regardless of using microwave or not, elastic bandage should be applied during the entire course of treatment. The duration of scar therapy is 6 months.
III.           Results
Outpatient follow up one month after the treatment, all wounds without pruritus were healed with only superficial scar or soft scar left. 50 cases were given the follow up in 6 months, only superfical scar or soft scar was inspected.
IV.           Discussion
The formation of scaring is either the benign fibrous hyperplasia of skin tissue or the over-excessive reaction of skin connective tissue to trauma. All of these patients are of cicatricial diathesis. As a result, the affected area after suffering from the traumatic injuries occurred inflammatory response and formed fibrous hyperplasia. Although there are many different approaches in the treatment of scars, but the clinical results are not ideal. Take liquid nitrogen for instance, it can take some effects on partial patients, but scar will reoccur rapidly after the intervention; the surgical removal and rotation skin flap in combination with radiation therapy make bigger impairment on the affected area and have high recurrent rate. Due to the repeated scratches caused by pruritus, the scar tissue is suffered the physical damage one after another. And then the hypertrophy of scarring is extensively promoted that is one key cause of keloid. By means of surgical removal of keloid, the affected area will be grown back without scar hypertrophy under the auspice of standard application of MEBT/MEBO. The advantages of this therapy embody as followed: i. MEBO Scar Ointment can effectively reduce the occurrence of inflammatory response, take impacts on stable supra oxygen free radical, change the local oxygen environment on wound bed, promote the wound healing and reduce the formation of scarring1 ii. MEBO Scar Ointment can effectively alleviate pain, pruritus and burns on the new epithelium or scar to prevent dryness, modulate the ratio and morphologic changes of epithelial cells and collagenous fibers; the pressure therapy combined to make the atrophy of capillaries, local ischemia and breakdown of collagenous fiber; besides the pressure can also relieve the scar edema. With the proper association with early exercises of affected joint, formed collagenous bundle will be growing in the alignment and order following the pressure direction to make reduction and disappearance of hypertrophic scarring2. But something needs to be paid attention: i. Control the depth of keloid excision; ii. Use MEBO Wound Ointment and MEBO Scar Ointment reasonably according to the instruction; iii. MEBO Scar Ointment should be used as early as possible, the therapeutic effects will be better and rapid; iv. Physical exercises could be given to improve the clinical results2.
We associated MEBT/MEBO with surgical removal of keloid in the treatment of keloid. That combination is a simple approach with significant effects and safety in keloid treatment. Therefore, it needs to be popularized and applied in medical facilities.
 [1] Xu Rong-xiang Bluebook of Burn Regenerative Medicine and Therapy[M]. Chinese Medical Science and Technology Press, 2000.
 [2] Fu Yong, Cui Guang-bei, Xu Chuan-zhen et al. The Experience of MEBO Wound Ointment in Combination with MEBO Scar Ointment in the Treatment of Hypertrophic Incisional Scar [J]. The Chinese Journal of Burns Wound & Surface Ulcers, 2006, 18(3): 219-221.
Background of writers
Wang Xiang-ning (1982-): female (ethnic Han), born in Liaoning province, graduated from Luzhou Medical College in 2005, residency.
Yang Zheng-bing (1979-): Male (ethnic Han), born in Sichuan province, graduated from North Sichuan Medical College in 2004, residency.
Xiong Hao (1976-): Male (ethnic Han), born in Chongqin, graduated from Chongqin Medical University in 2000, vice director of burn department, attending doctor.
 (Paper received on May 10th, 2010)
 (From The Chinese Journal of Burns Wounds & Surface Ulcers 2010, Vol.22. No.5)

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