摘要：Facial burns vary from relatively minor insults to severe debilitating injuries. Sustaining a burn injury is often a psychological trauma for the victim and is especially menacing when the face and neck are involved. This study was carried out on 60 patients with superficial dermal burns to the face admitted to the Burn Unit of Tanta University Hospital, Egypt, from September 2007 to July 2008. The patients were allocated randomly to one of three groups, each of which was treated with one of the following: sodium carboxymethyl-cellulose silver (Aquacel Ag?), MEBO? (moist exposed burn ointment), or saline-soaked dressing. We found that patients managed with MEBO? had less pain and itching and easier movement than those managed with Aquacel Ag?, while the Aquacel Ag? group required a shorter duration of time for healing, without any bad odour, than the MEBO? group. Quality of healing and patient satisfaction were nearly equal as regards MEBO? and Aquacel Ag?. Saline-soaked dressings were least satisfactory - they caused the most pain and itching, limited the patients' movements the most, needed the longest time for healing, and gave patients the least satisfaction. It was concluded that MEBO? was an excellent choice for management of facial burns owing to its soothing effect, ease of patient movement, easy handling, and good healing properties. Aquacel Ag? was found to be comparable to MEBO? and is specially recommended when frequent dressings cause difficulties for the patients or when they cannot accept a bad odour; saline-soaked dressings are not recommended for the management of facial burns because of the pain they cause, itching, limitation of patient movement, and delayed healing.

摘要：Objective:The objective is to outline the overall health scene as it is in New Zealand and to demonstrate that there is tremendous potential for the increased use of Moist Exposed Burn Therapy(MEBT)across a wide variety of health care facilities within New Zealand.Method:The presentation allows me to share with you evidence from clini- cal based practice and examples of how and where MEBT and the product Moist Exposed Burn Ointment(MEBO)has been used within New Zealand' s health services.This will include evidence from other nursing colleagues who work in the Aged Care sector or in the New Zealand community.Result:My experiences in the clinical field have enabled me to see that there is much that can be done through education for nurses by professional nurse educators. Currently there is little or no funding available to Nurse Educators for them to be able to provide the required education and training,or to be able to introduce the correct clini- cal techniques of MEBT into our heahhcare profession. Patients who require wound management and have been treated using the MEBT method are provided with sustained wound healing,improved outcomes and consequently an improved quality of life. New Zealand health providers are beginning to realize that use of MEBT and MEBO is a cost effective form of treatment.Not only in monetary terms but in ethical and physiolog- ical terms as well.At this point in time however,there is evidence that nurses will experi- ment with products such as MEBO but revert back to techniques and products they know and are comfortable with in day to day nursing situations. It can therefore be concluded that New Zealand nurses do not have adequate knowl- edge or understanding of the clinical application of MEBT/MEBO to achieve the optimum results for their patients. Ongoing education is essential to ensure that nurses,who are using MEBT,under- stand the principals of MEBT and follow the correct clinical application. There has been evidence,during my clinical practice,of New Zealand nurses using MEBT alongside the current New Zealand wound management techniques and this combi- nation has often led to a misunderstanding about MEBT and the incorrect use of MEBO. As a result the patient outcomes are often substandard compared with the recommen- ded MEBT practice and the resulting potential for the increased quality of life is not fully realized by patient or practitioner. With the acceptance of a changing methodology and its education within the New Zea- land nursing culture,there is significant potential for this wound management concept to be widely used,particularly within the Aged Care and Disabilities sectors within New Zea- land prior to registration of MEBO being granted. With the full registration of the MEBO product,we will be able to use this treatment to its full potential to provide improved patient outcomes and an increase in quality of life for patients within New Zealand. My clinical knowledge of MEBT has helped me to initiate a starting point of MEBT education in New Zealand-currently focused on regional nurse education and community awareness.This will help facilitate the understanding,enthusiasm and commitment for this treatment across New Zealand and enable nurses to gain the necessary support to bring a- bout this change in wound management.

摘要：Wound healing after dermal injury is an imperfect process, inevitably leading to scar formation as the skin re-establishes its integrity. The resulting scars have different characteristics to normal skin, ranging from fine-line asymptomatic scars to problematic scarring including hypertrophic and keloid scars. Scars appear as a different colour to the surrounding skin and can be flat, stretched, depressed or raised, manifesting a range of symptoms including inflammation, erythema, dryness and pruritus, which can result in significant psychosocial impact on patients and their quality of life. In this paper, a comprehensive literature review coupled with an analysis of levels of evidence (LOE) for each published treatment type was conducted. Topical treatments identified include imiquimod, mitomycin C and plant extracts such as onion extract, green tea, Aloe vera, vitamin E and D, applied to healing wounds, mature scar tissue or fibrotic scars following revision surgery, or in combination with other more established treatments such as steroid injections and silicone. In total, 39 articles were included, involving 1703 patients. There was limited clinical evidence to support their efficacy; the majority of articles (n?=?23) were ranked as category 4 LOE, being of limited quality with individual flaws, including low patient numbers, poor randomisation, blinding, and short follow-up periods. As trials were performed in different settings, they were difficult to compare. In conclusion, there is an unmet clinical need for effective solutions to skin scarring, more robust long-term randomised trials and a consensus on a standardised treatment regime to address all aspects of scarring.