Chapter Five

Clinical Principles of

Burns Regenerative Medicine and Therapy

Clinical Principles of Burns Regenerative Medicine and Therapy 

Standardized Local Treatment of the Burns Wound

Background Information of Standardized Local Treatment and Sources

In clinical burns treatment, as in all areas of medicine there is a ‘voltage drop’ between the rarified academic environment and the trenches of clinical practice. The clinician often cannot keep abreast of academic advances in treatment techniques. Many experienced doctors may disregard innovations preferring to stay with the ‘tried and true’. In some cases, fidelity to past protocols and maintenance of their dignity and reputation is more important than the actual therapeutic results experienced by their patients. Thus we see in medicine, as in all arenas of human commerce, an unfortunate phenomenon whereby the innovator must promote an improvement in the status quo to a temperamentally unresponsive professional audience. Rather than being accepted on their own merits, innovations are typically greeted with a cold shoulder and an unfortunate degree of suffering is visited upon patients until the paradigm shift is accomplished.   Rare is the doctor who seeks out and consults an inventor about proposed improvements in clinical protocols. Even in today’s information age where theories and practices can be easily investigated, many doctors remain unable or unwilling to consider proposed improvements to conventional and outdated treatment techniques.

In order to meet this challenge and to demonstrate to medical professionals and the public the benefits of an innovation in burns treatments, this chapter will present a comparison of two groups of clinical pictures of burns patients treated either by the contemporary methods or by the burns regenerative medicine and therapy (BRT) protocols (MEBO/MEBT). These pictures compel the viewer to rise above petty loyalties to different schools of thought and to rely instead upon the desire to offer the best possible care to those suffering from burn injury. These pages invite burns doctors around the world to join the collaborative effort and further this exciting area of research and clinical care.

The author has restrained himself from commenting on the relative therapeutic effects pictured below, choosing instead for the reader to experience their merit for him/herself.

Sources of Representative Cases

Case of extensive deep burns treated by conventional surgical dry therapy (excision and skin grafting, abbr. dry therapy): A case of 71 % third-degree burns, source from a burns center standing for the international level of burns surgery. Another case with 81 % third-degree burns treated with cultured composite autograft (CCA) technology, and the data from the international journal Burns [Vol. 25, No. 8, 1999].

Extensive deep burns treated by BRT (MEBT/MEBO): A case of 85 % third-degree extensive burns treated by a burns team led by Professor Rongxiang Xu who is the inventor of this therapy, data from The Chinese Journal of Surface Burns, Wounds and Ulcers, No.3, 1997.

Severity of Burns of Three Cases

In accordance with the international classifications and standards of burn severity, 3 cases were significantly comparable. Though there are remarkable differences in medical conditions, the results revealed many more differences in therapeutic effects (table 2). 

Table 2. Comparison of severity of burns and medical conditions among three cases

Compared Parts and Burn Depths

To accurately and objectively demonstrate the clinical treatment, anterior chest and face with comparable third-degree burns wounds in each case were selected for comparison. The case of composite autograft therapy serves as a reference to show the common ground and contemporary development of surgical excision and skin grafting therapy. Autografts are widely used in the standard surgical burns management and cultured composite autografts (CCA) have recently been used in the United States for skin grafting.

Standardized Local Treatment of Burns Wounds

To help facilitate the understanding of a variety of burn treatment techniques, 3 cases were compared at the following three clinical procedures: treatment of burnt skin, healing and closure of wound, and need for reconstruction after wound healing.

Case 1: Surgical Excision and Skin Grafting Burns Therapy

Background Information  

A 23-year-old male was burned when fire burned his cotton clothes ignited by steel residue at his workplace. Immediate antishock management was administrated at the factory clinic. At 4 h postburn, the patient was transferred and arrived at the hospital 7 h 20 min later. Upon arrival, initial assessment revealed that the patient suffered severe burns, including face and both auricles, anterior neck, both hands, chest, abdomen, left thigh and both legs; wound showing leather-like; dendritic vascular embolism. His vital signs included: T: 35.9 °C, P: 44/min, R: 32/min and BP: unmeasurably low. The patient developed hypovolemic shock postburn which was complicated by inhalation injury.

On admission, rapid fluid resuscitation was started to correct shock and tracheotomy was performed to improve ventilation. Escharectomy was then performed on the third-degree wounds of the left forearm and both legs to relieve pressure and improve blood circulation at the extremities. Superior vena cava puncturing and right cardiac floating catheterization were performed to monitor heart function. On day 2 postburn, surgical eschar excision to the underlying fascia and micro-particle autografting was performed on the extremities. On day 6, the patient received eschar excisions on the chest and abdomen, on which evenly holed allograft sheets were applied. Four days after the operation (day 10 postburn) small pieces of split-thickness autografts were placed on these wounds through the openings of the allograft. The patient developed severe Pseudomonas septicemia, and became comatose with low body temperature for 1 week. Septicemia was well controlled after intensive care. After that, repeated skin grafting was performed 9 times and most of the wounds healed. On day 43 postburn, corneal ulcer in the left eye occurred and was treated with eye drops and retrobulbar injection. Corresponding measures were taken to prevent stress ulcer, control infection and prevent pulmonary complications. The length of hospitalization was 70 days.

Procedure and Result (fig. 6, 7)

First Step: Treatment of Burned Skin

Dryness and debridement of eschar replaced the burn wound by a surgically included traumatic wound with neither burnt tissue nor skin tissue.

Second Step: Healing and Closure of Wound

Third Step: Reconstruction after Wound Healing

During a period of 14 months, nine surgical reconstructive operations were performed. However, disablement and disfiguration still presented.

Fig. 6. a. Before treatment.

 Fig. 6.b． Exposure and dryness of burned skin.

Fig. 6. c． Adopting various methods to enable dryness, dehydration and eschar formation of burned skin.

Fig. 6. d． Excision with electric knife and removal of dead burned skin, subcutaneous tissue together with viable fat layer down to the underlying fascia.

Fig. 6. e. Muscle layer covered by viable deep fascia appeared after excision.