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MEBO in Combination with MEBO Scar Ointment for Treating Hyperplastic Incisional Scar
Add Time£º2011/10/26 16:00:46
   FU Yong, CUI Guang-huai, XU Chuan-zhen, et al.
Affiliations: Dept. of Burns of the Affiliated Hospital of Binzhou Medical College, Binzhou 256603, Shandong Province, China
¡¾Abstract¡¿Objective: To observe the efficacy of MEBO combined with MEBO Scar Ointment in treating hyperplastic incisional scar. Methods: 79 hyperplastic incisional scars at 46 subjects were treated with MEBO after the scars were abraded. After wound healing, MEBO Scar Ointment was applied to prevent scarring. Wounds in limbs and joints were treated with pressure therapy. Results: After treatment, among the 79 scars, the markedly effective rate was 64.6%, effective rate 31.6%, total effective rate 96.2% and ineffective rate 3.8%. Conclusion: MEBO in combination with MEBO Scar Ointment treatment is effective in treating hyperplastic incisional scar after abrasion. It is safe, reliable and easy to operate, so deserves to be popularized.
¡¾Key words¡¿MEBO; MEBO Scar Ointment; Hyperplastic scar
Hyperplasia incisional scar not only affects appearance but also the quality of life due to its resulting itching and pain. However, there is no effective clinical approach to eliminate it at present. 46 patients with 79 hyperplasia incisional scars admitted between Sept., 2003 and Jun. 2005 were treated by MEBO in combination with MEBO Scar Ointment, which showed significant efficacy in all the hyperplastic incisional scars. Report as follows:
I. Clinical data and methods
1. Clinical data: Among the 46 patients with 79 hyperplasia incisional scars, 27 are male and 19 are female, aging from 27 months to 43 years old. Distribution of 79 scars: 8 on face, 12 on front chest, 14 on abdomen, 17 on joints and 28 on extremities. The scar length is 24mm~286mm , the width range is 4mm~16mm and the height range is 5mm~11mm.
2. Methods: Scars were abraded down to 1mm~2mm lower than normal skin after local anesthesia, and then applied MEBO evenly in the thickness of 1mm after sterilization, changed dressing every 4-6 hours. Or pressure bandage with MEBO gauze and changed dressing once a day. After wound heals (6-17d), applied MEBO Scar Ointment thinly, 3-4 times per day. Massaged the wound sites gently for 5 min~10min 20 days after treatment and washed the wound area with warm water every 4 days at least. The scars located in the limbs and joints were treated combined with pressure therapy with elastic bandage. The treatment course was one year.
II. Efficacy criteria and results
1. Efficacy criteria:(1) obviously effective: scars do not elevate or elevate no more than 2mm than the normal skin; without pain, itching and tightening sensation; the skin color changed from  reddish purple, bright red into or close to the normal skin color; soft and elastic; (2) effective: scars elevate less 5 mm than the normal skin; pain, itching and tightening reduced significantly; the skin color become less red; a little bit hard with certain elasticity recovered; (3) ineffective: no obvious changes in terms of signs and symptoms took place after treatment or even exacerbated. Efficacy evaluation is done in 1 year.
2. Results: Among the 79 hyperplasia incisional scars in 46 patients, after the combined treatment of scar abrasion, MEBO and MEBO Scar Ointment, 51 scars were obviously effective, accounting for 64.6%; effective locations were 25, accounting for 31.6%; 3 ineffective locations, accounting for 3.8%; and the total efficacy rate was 96.2%.
III. Introduction of typical cases
Patient Zhang: Male; 27 years old; right tibia fracture and skin lacerations on forehead due to car accident. Emergent treatments such as debridement, suture, open reduction and internal fixation with plate were adopted. The plate has been removed out for 2 years. Hyperplasia scar formed after wound healed, with the forehead scar being 40mm long, 5mm wide and 6mm; and the scar in right tibia being 146mm long, 9mm wide, and 7mm elevation. The skin at scarring sites was bright red, hard without elasticity; with discomfort such as pain and itching, more serious during the night. Topical use of MEBO after scar abrasion, wound epithelization occurred at ninth and 17th day respectively. And then applied MEBO Scar Ointment combined with elastic pressure bandage therapy. Pain and itching disappeared after 1 month¡¯s treatment; skin color changed close into the normal after 3months; after 10 months¡¯ treatment, the skin returned to be flattened, softened and more elastic. Scar kept stable with no occurrence 1 year after the withdrawal of MEBO.
IV. Discussion 
   Scarring is the final and natural result of wound repairing, which is also an important part of human body defensive system. Any kind of wound healing would result in scar formation of various degrees [1]. Mechanism of scar formation has already been revealed: that is, fibroblast excessive hyperplasia, deposition of collagen and extracellular matrix. Based on lots of experimental studies, it is widely believed that scar formation is the consequence of inflammatory response, the imbalance between collagen production and degradation, the appearance of abnormal mucopolysaccharide and myofibroblasts hyperplasia [2].
Hypertrophic scar is elevated, irregular and uneven with flush and congestion, and also hard in texture. Burning pain and itching would be more serious under the situations that ambient temperature is elevated, the patient is agitated or has spicy food. There are histological differences between hypertrophic scars and normal scars. The later features the thickness of collagen fiber deep in the scar, irregular arrangement, swirling-like or cord-like shape; mucoprotein deposit occurs in the swirling-like or cord-like collagen, so as to form firm lump. While in the case of hypertrophic scarring, the major cause of it is that the abnormal continuous anabolism of collagen protein exceeds the catabolism of it, so that large amount of collagen fiber would be produced in a long time. Some topical or systemic risk factors may be commonly found. Topical factors include foreign body, inflammation, stretch, etc., while the systemic factors, for example, the young adult and women, especially pregnant women and patient with hyperthyroidism, are more likely to suffer from hypertrophic scarring, which may be related to the overproduction of estrogen and hormones in pituitary. Furthermore, race, heredity and physical constitution may also contribute to the scar formation.
Hypertrophic scar is a hot potato of modern medicine and there are many approaches to treating it. In recent years, the most commonly used approaches include pressure therapy, laser therapy, ultrasound, ultraviolet therapy, cryosurgery, silicone gel, medication injection, radiation therapy, surgery and etc.. Single use of any approach can not achieve the satisfying effect; so many approaches should be used comprehensively, although the comprehensive treatment can only make the scar shallower in deep and lighter in color. However, MEBO can decrease the inflammatory response at the wound effectively, remove superoxide anion radicals that affect tissue stabilization and improve the oxygen supply at the wound surrounding, and eventually improve the wound healing and reduce the scar formation [3]. MEBO Scar Ointment is effective in relieving pain, itching, burning of the scar or the newly-growth epidermis, moistening the scar tissue, regulating the ratio between epithelial cell and collagen fiber as well as their morphological changes. Pressure therapy with elastic bandage can exert pressure on blood vessels to the extent that exceeds the intra-capillary pressure, which would lead to capillary atrophy, local ischemia and collagen fiber damage. Pressure can also relieve the scar edema, coordinate with the involved joints to do the early functional exercise properly, and make sure the growth and arrangement of the fiber bundles are along with the force direction. So that, the collagen fiber at the scar site can arrange in order; the capillaries and the collagen fiber can be re-regulated and re-arranged to their normal state, thus, to relive or remove the hypertrophy scar. QIU Shi-guo [4] has demonstrated the efficacy of MEBO and MEBO Scar Ointment in treating hypertrophy scar resulting from burn and scald.
Combined with surgery, topical use of medications and pressure therapy, MEBO treatment can heal the wound physiologically, reduce the scar formation and prevent the occurrence of the hypertrophic scar in the incisional site. Therefore, it should be promoted and popularized in the hospitals at different levels with the advantages of easy-to-operate, effective, safe and reliable. Precautions during treatment: (1) control the depth of abrasion ; (2) use MEBO and MEBO Scar Ointment according to the instructions; (3) MEBO Scar Ointment should be used as early as possible for good efficacy and fast action ; (4) strengthen functional exercises for better result during the treatment.
[1] LI Ao, YANG Guo-fan, GUO An-qin. Complete Work of surgery: Plastic and Burn Surgery [M]. Beijing: People¡¯s Military Medical Press, 1996, 348~349.
[2] LI Chuan-ji, et al. Clinical Application and Efficacy Evaluation of MEBO Scar Ointment [J]. The Chinese Journal of Burn Wounds & Surface Ulcers, 2002, (3):159~160.
[3] XU Rong-xiang. Clinical Handbook for Burns Regenerative Medicine and Therapy [M]. Beijing: Chinese Medical Science and Technology Press, 2000: 18~43£®
[4] QIU Shi-guo, et al. Efficacy Analysis of MEBO and MEBO Scar Ointment in the Treatment of Hypertrophy Scar from Burn and Scald [J]. Chin J Clin Rehabil, 2004, 17(8): 3359.
¡¾About the Authors¡¿
FU Yong (1978): Male (Han); Physician; born in Binzhou city, Shandong Province, China; graduated from Qingdao Medical College in 2001.
CUI Guang-bei (1963): Male (Han); Chief of the department, associate chief physician; born in Jining City, Shandong Province, China; graduated from Binzhou Medical College in 1988.
XU Chuan-zhen (1979): Male (Han); Physicianp; born in Weifang City, Shandong Province, China; graduated from Binzhou Medical College in 2002.

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