MEBO Applied to the Granulation Wound of Burn after Skin Grafting

54 cases of burn were treated with MEBT.  MEBO was directly applied on the granulation wounds after skin grafting. Clinical and histopathological observations were conducted and revealed that the skin graft on the granulation wounds multiplied and enlarged quickly. 

The number of fibroblasts or fibrocytes in the granulation tissues of MEBT group was much fewer than that of non-MEBT group and proved that MEBO was beneficial to the enlargement and the survival of skin graft. It is probably capable of restraining the multiplication of fibroblasts.

Half exposed method in treating the granulation wound of burn after skin grafting using single layer of large mesh gauze with antibacterial medicines was usually adopted in the past.

This method had the following advantages compared with bandaging method:

it was convenient to observe the burn wound and infection was easy to be controlled and the amount of dressing could be reduced.

However, if purulence accumulation or infection beneath the gauze occurred, the survival rate of transplanted skin graft could be affected. Mechanical injury, aching of burn wound, haemorrhage and skin graft avulsion could occur because of the adhesion of gauze when wound dressing was changed.

54 cases of granulation wound with skin grafting were treated with MEBT in our department from August 1989 to June 1991. The previous problems were solved and the effect was satisfactory.

Time of medicine application:

A layer of large mesh gauze with antibacterial medicine was used as the inner dressing after skin transplantation and sterile gauze with pressure dressing was applied externally. The external dressing was removed after 3 days and MEBO was spread onto the single large mesh gauze that was preserved. The inner large mesh gauze was removed after 4~6 hours and MEBO was spread onto the burn wound directly and wound dressing was changed once every 4~6 hours.

Method of medicine application: 

MEBO was spread with sterile tongue depressor or cotton stick onto the burn wound evenly with a thickness of 1 mm. The range of the medicine was 1 cm larger than that of the burn wound. The burn wound was exposed thoroughly and was covered with medicine all the time. 

The liquified matter at the burn wound was wiped off with sterile paper or cotton stick timely to avoid friction or pressure suffered by the burn wound. Attention should be paid to avoid erasing the skin graft within a week after skin grafting. Proper external fixation should be adopted when the patients fell asleep.

The outstanding advantage of MEBO application onto the burn wound after skin grafting was: there was no dressing covering the burn wound so the burn wound was exposed thoroughly. 

Gauze didn’t need to be changed and it was convenient for observation and debridement. The mechanical injury or avulsion of transplanted skin graft caused by the cohesion of gauze and burn wound when the wound dressing was changed was avoided. 

No aching, haemorrhage or transplanted skin graft avulsion on the burn wound occurred during the course of medicine application in this group.

In addition, MEBO has the ability of draining exudation at the burn wound. The debridement of the burn wound and change of wound dressing in time could avoid the infection of the burn wound and the dissolving of the skin graft.

The pathological examination on the granulation tissues showed that the amount of fibroblasts of MEBT treatment was less than that of non-MEBT treatment significantly. It showed that MEBO could restrain the growth﹑proliferation of fibroblast and decrease the formation of scars. It deserved further investigation.

For the time of applying MEBO onto the burn wound after skin grafting, it is considered feasible to open the dressing and smear MEBO onto the lesion area 3 days after transplantation. 1~2 days after skin grafting, the nutrient was supplied mainly through the exuded plasma. 

The cohesion of skin graft and the burn wound was not fast, so during this period, bandaging method was adopted to fix and protect the transplanted skin graft from erasure and the pressure was maintained to make the skin graft and the burn wound stick to each other tightly. 

Newly born capillaries had grown into the skin graft 3 days after skin grafting and relatively fast fibrous connection formed between the skin graft and the burn wound and the skin graft couldn’t be erased easily. 

On the contrary, if we opened the dressing too late or bandaging method was continued, purulence and blood accumulation beneath the skin graft couldn’t be observed timely. Infection of burn wound or dissolving, necrosis of transplanted skin graft would occur.

Full Report:
MEBO Applied to the Granulation Wound of Burn after Skin Grafting, The Chinese Journal of Burns, Wounds and Surface Ulcers 1995(3): 42-43