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：Introduction The objective of this study was to investigate the clinical effects of laser therapy in treating cicatricial ectropion. Methods Seven patients with cicatricial ectropion were entered into this clinical study. The ectropions were pretreated with the 595-nm pulsed dye laser if the scar color was red. If there was no red, the UltraPulse fractional CO2 laser was used and parameters were adapted according to the height of scar. MEBT/MEBO was used after laser treatment for wound healing. The degree of ectropion was measured for changes before and after treatment, and the scars were evaluated for changes in melanin, height, vascularity, and pliability using the Vancouver Scar Scale (VSS) before and after treatment. Results All seven patients with cicatricial ectropion entered into this protocol were completely corrected after 1-2 treatment sessions. The total VSS score, as well as the score for melanin and pliability in 7 patients, showed a decrease following the treatments, and this was statistically significant (P < 0.05). The scores for height and vascularity showed a decrease following the treatments, but there was no significant difference by statistical analysis (P ≥ 0.05). There were no adverse reactions reported. Conclusions The treatment of cicatricial ectropion with laser therapy can not only correct the ectropion, but also improve the scars in the treatment area. Compared with the traditional repair of cicatricial ectropion, the use of fractional CO2 laser provides surgical precision and the advantage of a timely treatment without the need to wait for the scar to stabilize.

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.

摘要：Poor wound healing remains a critical problem in our daily practice of surgery, exerting a heavy toll on our patients as well as on the health care system. In susceptible individuals, scars can become raised, reddish, and rigid, may cause itching and pain, and might even lead to serious cosmetic and functional problems. Hypertrophic scars do not occur spontaneously in animals, which explains the lack of experimental models for the study of pathologic scar modulation. We present the results of three clinical comparative prospective studies that we have conducted. In the first study, secondary healing and cosmetic appearance following healing of partial thickness skin graft donor sites under dry (semi-open Sofra-Tulle dressing) and moist (moist exposed burn ointment, MEBO) was assessed. In the second study, healing of the donor sites was evaluated following treatment with Tegaderm or MEBO, two different types of moisture-retentive dressings. In the third study, 3 comparable groups of primarily healed wounds were evaluated. One group was treated by topical antibiotic ointment, the second group was treated by Moist Exposed Burn Ointment (MEBO), and the third group did not receive any topical treatment. In the second study, secondary healing of partial thickness skin graft donor sites was evaluated following treatment with Tegaderm or MEBO, two different types of moisture-retentive dressings. In the second and third studies, healed wounds were evaluated with the quantitative scale for scar assessment described by Beausang et al. [1] Statistical analysis revealed that for both types of wound healing, scar quality was significantly superior in those wounds treated with MEBO.