摘要：BACKGROUND? Laser resurfacing has now become an accepted and important component of facial rejuvenation. With the introduction of computerized scanning systems, the actual laser resurfacing technique has been greatly simplified; however, the final outcome still depends to a large extent on the efficiency of the postlaser wound care in promoting wound healing and preventing early and late complications. It has been repeatedly confirmed that a moist environment is the single most important external factor affecting the rate of re-epithelialization. Occlusive moisture-retentive dressings, however, are difficult to apply and maintain in position and may as well be complicated by serious infections. OBJECTIVE? Moist exposed burn ointment has been shown to maintain adequate moisture for optimal healing by frequent ointment application without the need for a secondary overlying dressing. It would be ideal for postoperative laser care. METHODS? Twenty-eight consecutive patients treated with coherent ultrapulse CO2 laser in Toulouse, France, were included in the trial. Moisture-retentive ointment was applied over the treated areas every 4 to 6 hours. Healing was assessed clinically and with repeated transepidermal water loss measurements. Swab cultures were taken, and pain was evaluated with a visual analog scale. Colorimetric analysis of pictures taken was statistically compared with picture analysis of 20 patients treated earlier with an occlusive dressing. RESULTS? Uneventful timely healing occurred in all patients with minimal pain and discomfort. Healing with moist exposed therapy resulted in faster recovery of cutaneous erythema, as evidenced by colorometry. CONCLUSION? Moist exposed burn ointment application can be safely considered a good and valid alternative to occlusive dressings for postoperative laser care.

摘要：In laser-induced partial-thickness burns of pig skin, moist exposed burn ointment (MEBO) produces a moist environment, allows drainage of exudates, reduces eschar formation, and accelerates debridement and wound healing. A prospective multi-center study was conducted to evaluate the effect of MEBO on the healing of partial-thickness burn wounds. We included 52 patients with 100 burn sites ranging from 0.5% to 15% total body surface area in the study. Treatment efficacy was assessed on physical examination of the wound, the course of time of trans-epidermal water loss (TEWL) and moisture values, bacterial wound colonization and the degree of pain experienced by patients during and between dressing changes. Using the Visual Analogue Thermometer device (VAT) a progressive decrease of pain was found throughout the treatment which was statistically significant at 6, 9 and 12 post-burn days. TEWL, as an indicator of re-epithelialization, demonstrated a decreasing trend on day 3, and the reduction became significant from the 6th post-burn day. Moisture was significantly decreased during the first 5 post-burn days. As re-epithelialization progressed there was a net decrease in moisture paralleling TEWL. After 1 week of MEBO treatment, bacterial wound colonization decreased to 10% in the immediate group and to 61% in the late group of application. By the second week, colonization dropped to 5% and 23% respectively. Topical ointment application contributed to the debridement of the wound bed facilitating rapid epithelialization within 2–6 days, depending on the burn depth. MEBO is an ointment that can effectively produce a moist and wet environment for optimal healing of partial-thickness burns.

摘要：The history of wound care and management closely parallels that of military surgery which has laid down the principles and dictated the practices of wound cleansing, debridement and coverage. From a treatment standpoint, there are essentially two types of wounds: those characterized by loss of tissue and those in which no tissue has been lost. In the event of tissue loss it is critical to determine whether vital structures such as bone, tendons, nerves and vessels have been exposed. It is also important to determine the amount of soft tissue contusion and contamination. In any case primary wound healing by early closure either primarily or with the help of grafts or flaps is preferred to secondary healing and wound contraction with subsequent contractures which interfere with range of motion and function. Whether the wound is acute or chronic, essential principles of wound care must be observed in order to avoid wound sepsis and achieve rapid and optimal wound healing. - Tissues must be handled gently. - Caustic solutions capable of sterilizing the skin should never be applied to the wound. It is desirable never to put anything in the wound that cannot be tolerated comfortably in the conjunctival sac. - All devitalized tissues must be debrided either hydrodynamically, chemically, mechanically or surgically. - All dead space must be obliterated. - Exposed vital structures must be covered by well vascularized tissues. An essential part of any wound management protocol is wound dressing. It cannot be too strongly emphasized that a wound dressing may have a profound influence on healing particularly of secondary type healing, a critical feature being the extent to which such dressing restricts the evaporation of water from the wound surface. A review of available dressing materials is reported with emphasis on the newly developed concept of moist environment for optimal healing. a practical guide for dressing selection is also proposed.

摘要：Objective:Moist Exposed Burn Ointment(MEB0)has been initially popularized by the Beijing Chinese Burn Center as a topical burn oint- ment capable of providing the necessary moist environment for optimal wound healing without an overlying secondary cumbersome bulky and expensive dressing. Chinese traditional medicine(CTM)is quite different from the type of medicine and approach to disease as practiced in the west. Despite its empirically time proven practices and remedies,it is difficult,however,to accept CTM without adapting it to western ways of scientific analysis and documentation and many obstacles must be overcome before adopting it in a western style medical practice.Methods:Even though the effects of MEBO have been well described in the Chinese literature,the ointment had to be sub- jected to our ways of scientific analysis and documentation before being adopted.Sev- eral clinical studies were conducted to demonstrate the effect of MEB0 on primary healing of surgically repaired cutaneous wounds and on secondary healing of split thickness skin graft donor sites. Its effect on scar quality following both primary and secondary healing was also elucidated.Wound healing cytokine modulation by MEBO was investigated experimentally using the rabbit burn model.Results:Split thickness skin graft donor site wounds treated by the moisture retentive ointment had faster re- epithelialization rate than conventionally treated wounds with Sofra-Tulle or with oc- clusive Tegaderm dressings and were markedly less hyperemic and pigmented. Final cosmetic appearance as documented photographically,as well as patient's satisfaction and preference were much superior for the MEB0 treated wounds.It was demonstrated also that the ointment under investigation not only provided optimal and rapid re-epi- thelialization of partial thickness wounds but also resulted in faster functional cutaneous recovery as determined by TEWL(trans-epidermal water loss)measurements.It re- suited also in better quality healing as evidenced by lack of epidermal sliding.The ex- perimental study demonstrated that the multitude of inflammatory cells,growth factors and cytokines present in the wound bed are positively modulated by topical application of MEBO with characteristic temporal and spatial regulation and changes in the expres- sion pattern.Conclusion:Despite the fundamental differences between CTM and west- ern style medicine,it is wrong to totally disregard CTM only because some of its ingre- dients are unknown to our pharmacopea or because the complex nature of the Chinese medicinal preparations preclude isolation of the various constituents for exact toxicologi- cal and pharmacological investigation either separately or in combination with each oth- er.Our studies have clearly demonstrated the beneficial effects of MEBO on wound healing and scar quality.This effect is not merely due to moisture retention but rather to a fundamental basic modulation of wound healing kinetics.Furthermore,the experi- mental study has proven that wound healing modulation could be achieved by simple ointment application without the need of sophisticated and expensive high-tech mo- dalities such as cytokine and gene therapies.