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Clinical Effect of MEBO in the Treatment of Skin Ulcers in Elderly Diabetic Patients
Add Time£º2011/8/29 16:24:38
¡¾Abstract¡¿ Objective: The study was designed to investigate the efficacy of MEBO in the treatment of skin ulcers in elderly diabetic patients. Methods: 57 elderly diabetic patients with skin ulcers were treated with burn cream. Results: The wound surface covered by granulation tissue and wound closure was achieved in 28 cases. 26 cases achieved wound closure with granulation wound granular skin grafting in cultured fresh granulation tissue. After active treatment wound conditions were improved in 3 patients who were then discharged. Conclusion: Burn cream had a significant therapeutic effect on skin ulcers in elderly diabetic patients.
¡¾Key words¡¿ MEBO; diabetes; skin ulcer

Clinical data of 57 elderly diabetic patients with skin ulcers treated in our department during 2001 ~ 2007 were collected. Application of MEBO for the treatment of wounds was associated with improved wound healing rate and satisfactory results, which were analyzed as follows:
1. Clinical data
A total of 57 patients were enrolled (26 males, 31 females, aged 60 to 78 years old, with an average age of 68 years old). Wound area was 0.8cm ¡Á 0.6cm ~ 4.5cm ¡Á 7.0cm, duration of disease was 5 years to 16 years with an average of 11 years. Wound site: both feet in 35 cases, both lower extremities in 9 cases, both upper extremities in 7 cases, hip in 6 cases. All patients suffered from single ulcer and the necrotic tissues infiltrated to muscle layer. Wound was covered by black dry eschar, or yellow-white pus moss. The inner layer dressing was light green, with sweet smell of fish. Wound granulation tissue was not adequately fresh, dark, and had a concavity to normal surface.
2. Therapeutic method
2.1. Debridement: After admission, patients accepted repeated wash of wound with sterile saline to cleanse the wound and circumjacent skin. Necrotic and inactivated tissues were removed with surgical knife, viable tissues were preserved. Not to cause a new injury and a small amount of wound bleeding were regarded as desirable.
2.2 Unobstructed drainage: MEBO was applied on wound evenly with a 2mm ~ 3mm thickness, then covered with MEBO oil carbasus, the dressing was changed 2 or 3 times daily. Or on this basis, we applied proper pressure dressing with 5 ~ 6 layers of sterile carbasus, and the dressing was changed once daily. If there were excessive wound exudates, the dressing change frequency should be increased.
2.3 Anti-infective and nutritional support: while strengthening of wound treatment, blood sugar was controlled in normal range. Effective antibiotics were chosen for the prevention and treatment of infection according to wound status or the results of drug sensitivity test. Amino acids, fat emulsion, plasma, albumin were infused to improve the nutritional status of patient and promote wound healing.
3 Results
The wound surface covered by granulation tissue, initiation the crawling growth of wound circumjacent epithelial to wound center and the wound closure was achieved in 28 cases. In 26 patients with large wounds (> 2.0 cm ¡Á 2.0 cm) or poor nutrition (in particular, wounds located within the lateral malleolus, anterior tibial and dorsalis pedis), the necrotic tissue was gradually eliminated and fresh granulation tissue was cultured by the drug effect. Granulation wound granular skin grafting was used in the latter 26 patients to achieve wound closure. Due to other reasons 3 patients whose wound conditions were improved after positive treatment received an automatic discharge.
4. Discussion
4.1. Physiological characteristics of skin in elderly diabetic patients
With the increase of age, body physiological function reduce gradually, leading to attenuated blood supply to tissue cells, lower oxygen supply, therefore skin is susceptible to ulcers, with poor local blood supply and serosity or putrilage covering the surface. With the extension of time, serious fibrous tissue hyperplasia leads to difficulties in epithelial repair. Due to long-term hyperglycemia, the function of tissues and organs of elderly diabetic patients is decreased, metabolism rate is reduced, coupled with reduced blood vessel elasticity, increased blood viscosity or the influence of heart, pulmonary vascular disease [1], decreased immune function, skin dystrophy caused by skin thinning and long-term dermal microvascular and peripheral neuropathy, ulcers lost barrier function and glucose content in wound exudate increase, which all facilitate bacterial growth and reproduction. The chance of wound infection is developed at early stage and more severe than normal population, therefore, treatment of skin diseases of elderly patients with diabetes is a major problem.
2. Treatment of skin ulcer in elderly diabetic patients
(1) Control of blood glucose: first of all, positive measures should be taken to control blood sugar to normal range. The rational use of insulin not only controls blood sugar, but also inhibits the production of pro-inflammatory cytokines and free radicals, playing a role in protection of other organs [2].
(2) Infection control: First of all, active treatment of the wound should be noted. The persistence of necrotic tissue is a serious source of infection in vivo, meanwhile inhibiting the growth of deep granulation tissue. Some necrotic tissue is tenacious and closely attached, which could be separated into strips. The use of moist burn drugs to enter the deep tissues along the scarification could obtain the pharmacodynamic effect of drug. When necrotic tissue and normal tissue separated, the drug can be easily removed. The dressing should be changed daily to ensure the unobstructed drainage of the wound. If secretion increased, the frequency of dressing change should increase to avoid wound impregnating, infection and inhibition of the growth of granulation tissue. Infection prevention and control should be actively followed. Appropriate application of preventive antibiotics is necessary, regular wound secretion culture and sensitivity test should be performed for selection of effective and sensitive antibiotics. When the laboratory test results of bacteria is not available, the timely application of empirical antibiotics based on epidemiological data of patient area combined with patients status, and must take account of Gram-positive cocci and gram-positive bacteria [3]. Do not wait for test results which might results in treatment delay. At the same time, duration of continued use of preventive antibiotics should be based on patients conditions [4 ~ 6].
(3) Promotion of healing: MEBO could create a partial physiological moist environment, stimulating the potential regenerative cells in deep wound to convert into stem cells, and their activation, splitting, proliferation and differentiation to normal skin tissue structure at the original site in the wound, to repair skin wounds and reduce scar. MEBO can reduce inflammation, improve wound microcirculation and promote the growth of granulation tissue and initiate the crawling of epithelium. The use of drugs with activating blood circulation and dissipating blood stasis effects such as Salvia miltiorrhiza and 654-2 could improve blood circulation in organs and tissue, providing the necessary supply of nutrients for repair. To strengthen the nutrition support, attention should be paid to the supplement of energy and protein, and a variety of vitamins and trace elements, intensified care and prevention of pressure ulcers [7]. After positive treatment if the wound do not heal, granulation wound granular skin grafting could be used. A small piece of normal skin from an area adjacent to the edge of wound could be processed into 1.0mm ¡Á 1.0mm granular skin and planted on granulation wound. Skin nail could be observed in about a week and confluent gradually to achieve wound closure.
In summary, in the course of treatment we took active measures such as controlling blood glucose and the use of MEBO burn cream to activate the potential regenerative cells and promote wound healing, shorten the duration and reduce patient suffering, improve the quality of life.
[1] Yang Zongcheng, ¡°Burns Treatment [M]¡± Third Version, People's Health Publisher, Beijing, 2006. 409~410
[2] Wang Minjun, Qing Chun, Liao Zhenjiang, eds, ¡°Biological Characteristics of Dermal Fibrous Cells after Deep II Burns of Diabetic Rats [J]¡± Chinese Journal of Burns, 2006, 22:42~45
[3] Xu Weishi, ¡°Experienced Application of Antibiotics in the Treatment of Burns Infection [J]¡± Chinese Journal of Burns, 2002, 18:71~72
[4] Shang Guangfu, ¡°New Concepts for Prevention and Treatment of Burns Infection [J]¡±, Chinese Journal of Burns, 2005, 21:83~84
[5] Owens RC Sr. Ambrose PG, Nightingale CH, eds. ¡°Antibiotic optimization: Concepts and Strategies in Clinical Practice [J]¡± New York: Marced Dekker 2005. 491~518.
[6] Denhar Ln, Wunderink RG, Habip MP, et as. ¡°High-dose, short-course levofloxacon for community-acquired pneumonia: A new Treatment Paradigm¡±. Clin Infect Dis, 2003. 37:752~760.
[7] Xu Rongxiang, ¡°Regenerative Medicine Research [M]¡± the Medicine Science and Technology Press of China, Beijing, 2002.1~21
Brief Introduction of the authors
Li Qinghua (1976~), Female, Yantai in Shandong Province, graduated from the Department of Clinic Medicine of Taishan Medical School, Chief Doctor
Liu Xia (1975~), Female, Tai¡¯an in Shandong Province, graduated from Nursing Department of Taishan Medical School, Nurse Practitioner
Gong Peixin (1964~), Female, Tai¡¯an in Shandong Province, graduated from Nursing Department of Taishan Medical School, Vice Professor

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