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Use alginate dressings to heal hard-to-heal burns

We have previously discussed many studies on the application of alginate dressings to various types of chronic wounds, such as bedsores, diabetic foot ulcers, etc. Burn wounds that are difficult to heal are also chronic wounds and require high healing conditions. But it’s worth trying. From January 2005 to June 2009, in the Burn Department of Jinan Central Hospital Affiliated to Shandong University, doctors used random controlled observation to select 60 patients with refractory wounds who were treated in outpatient or inpatient burn departments during the same period, including 40 males and 20 females. Example: Age 3~56 years old.

Burns generally refer to tissue damage caused by heat, including hot liquids (water, soup, oil, etc.), steam, high-temperature gases, flames, hot metal liquids or solids (such as molten steel, steel ingots), etc., mainly It refers to the skin and/or mucosa. In severe cases, it can also damage subcutaneous or/and submucosal tissues, such as muscles, bones, joints and even internal organs.

After a burn injury, the assessment is based on the extent of the burn. The definition of refractory residual wounds is currently unclear, but it is generally understood to be wounds that have not healed after surgery and conservative treatment six or seven weeks after the burn. The mechanism of occurrence is as follows: ① Improper early treatment. If skin grafting is not done in time after III degree burns or the skin grafting gap is too large (including the gap between skin grafts is too large due to failure of skin grafting) and the skin grafting is not replanted in time, it will cause wound edema and the formation of aging granulation tissue. The base is hard fiber plate, which affects venous return and makes The wound eroded or formed an ulcer, which took a long time to heal. ②Scar tissue or newly healed wounds will rupture and form ulcers when encountering minor trauma due to poor blood circulation and poor expansion ability. The new epithelium is thin and cannot withstand friction. ③Stubborn infection. For example, infections caused by drug-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and streptococci may cause repeated ulceration of the wound and may cause the skin graft to dissolve, resulting in surgical failure. ④ Incomplete debridement of wound tissue.

The healing of burn wounds is a process of continuous tissue repair, which is based on a series of activities of tissue repair cells such as inflammatory cells, fibroblasts, and endothelial cells. These activities are affected by systemic and local factors, among which Local factors are more important. In comparison, refractory burn wounds take longer to repair, are more difficult to heal, and are affected by more factors. The microenvironment of the wound, including the humidity, temperature, pH value of the wound, etc., will all affect the healing of the wound. In addition, burn wounds that are difficult to heal are mostly infected by drug-resistant bacteria, and bacteria reproduce quickly. Human body temperature, wound exudate, and necrotic tissue are good survival conditions for bacteria. Timely cleaning of wound exudate and necrotic tissue is an effective way to block bacterial growth. Therefore, the key to treating refractory burn wounds is to control wound infection, provide a suitable microenvironment for wound healing, promote cell regeneration and repair, and improve systemic resistance. It is extremely important to have a wound covering with excellent performance after a burn. At this time, the dressing can protect the wound, prevent the loss of body fluids and proteins, prevent bacterial invasion and cause inflammation, and provide support for proliferating cells.

Currently, traditional dressings commonly used in clinical practice include various gauze, cotton pads, etc. Traditional dressings have low cost, wide sources of raw materials, soft texture, strong absorption capacity and can prevent the accumulation of exudate on the wound surface, and have a certain protective effect on the wound surface. They are still widely used in various types of wounds. However, with further understanding and requirements for wound healing, traditional dressings have increasingly shown their limitations.

Vaseline gauze is a traditional dry dressing. It is simple to make, can protect the wound surface to a certain extent, is breathable and has certain hygroscopicity. However, the petroleum jelly component in the dressing has a certain stimulating effect on the wound surface; the surface of the dressing is rough and dry, and it is easy to rub the wound surface and cause damage; new granulations on the wound surface can easily grow into the mesh of the dressing, causing pain and damaging the wound surface during dressing changes; Vaseline gauze absorbs It has poor sex and is not easy to accept for patients with a lot of wound exudation.

Synthetic dressings commonly used clinically include film type and foam type. Film dressings are formed by coating one side of a biomedical film with pressure-sensitive adhesive. The inner layer of hydrophilic material can absorb wound exudate, and the outer layer of material has good air permeability and elasticity. This type of dressing has a transparent appearance and is easy to observe; after use, it can keep the wound surface moist and promote the shedding of necrotic tissue. However, after the dressing is saturated, it is easy to accumulate exudate under the membrane, which may induce or aggravate infection. Therefore, it is only suitable for relatively clean wounds and is not suitable for exudative and infectious wounds. Foam dressings are porous and have a large absorption capacity for liquids. This type of dressing has a good protective effect on the wound, has strong heat preservation and moisturizing capabilities, is lighter, and the patient feels more comfortable. However, some dressings require external fixation materials due to poor adhesion; dressings are generally opaque, making it difficult to observe the wound condition; dressings have large pores, and granulation tissue can easily grow into the wound surface, making it difficult to remove the membrane, and are susceptible to bacterial contamination.

Therefore, an ideal dressing for burn wounds should have the following functions: ① It has good adhesion and adheres well to the wound surface, but should not adhere to the wound surface to avoid secondary damage caused by changing the dressing. ② It can not only maintain the normal permeability of water and heat, but also prevent excessive loss of water and body fluids. ③ Good biocompatibility, non-toxic and non-antigenic, and preferably have the function of promoting wound healing. ④Durable and flexible. ⑤ It has a barrier effect on bacteria, can resist bacterial invasion and prevent infection.

Since Winter proposed that a moist environment can promote wound healing, the concept of functionally active dressings has emerged. Its basic function requires maintaining a moist healing environment and protecting the wound from bacterial infection. With the in-depth development of research related to wound healing, the wet healing theory has been accepted and widely used by clinical medical workers. For wounds that have not healed for a long time, wet dressings can provide a moist environment that is optimal for wound growth, and are conducive to the dissolution of necrotic tissue and the proliferation and differentiation of tissue cells. It can also stimulate the growth of new capillaries and promote the growth of granulation tissue.

We have previously discussed many studies on the application of alginate dressings to various types of chronic wounds, such as bedsores, diabetic foot ulcers, etc. Burn wounds that are difficult to heal are also chronic wounds and require high healing conditions. But it’s worth trying. From January 2005 to June 2009, in the Burn Department of Jinan Central Hospital Affiliated to Shandong University, doctors used random controlled observation to select 60 patients with refractory wounds who were treated in outpatient or inpatient burn departments during the same period, including 40 males and 20 females. Example: Age 3~56 years old.

Inclusion criteria: ① Patients with burns clinically diagnosed as moderate or above; ② Patients whose wounds fail to heal after routine debridement, skin grafting surgery and anti-inflammatory treatment for more than 6 weeks. Exclusion criteria: patients with diabetes, peripheral vascular disease, rheumatic immune diseases and other diseases that affect wound healing.

Causes of injuries: 36 cases of hydrothermal burns, 12 cases of flame burns, 9 cases of arc burns, and 3 cases of chemical burns. Among the 60 patients, 14 had severe burns, 43 had severe burns, and 3 had moderate burns. The burn area was 5% to 90% TBSA (the area of ??third-degree burns was 2% to 85% TBSA), and the residual wound area was 0.3% to 85%. 6%TBSA, the residual wound time is 45~90 days.

60 patients were randomly divided into a conventional dressing group and an alginate dressing group, with 30 patients in each group. There was no significant difference in age, gender, wound area, general condition and other factors between the two groups. (all P > 0.05). In accordance with the provisions of the "Medical Institution Management Regulations" of the State Council, the patient gave informed consent.

The wounds of both groups of patients were rinsed with normal saline and wiped dry with sterile dry cotton balls. In the conventional dressing change group, the wound surface was covered with Vaseline gauze and covered with sterile gauze. In the alginate dressing group, the wound was covered with an alginate dressing of the same size as the wound, plus sterile gauze. The wound dressings of the two groups of patients were changed every two to three days until the wounds healed.

Main observation indicators: ①Wound healing time: Complete healing is considered when there is no leakage from the wound surface and autologous epidermal cells expand and fuse into sheets to cover the entire wound surface. ②Wound secretions and local inflammatory reaction. ③Influence on skin quality after healing of difficult-to-heal wounds: including the occurrence of blisters after wound healing, ulceration of newly healed wounds, and scar hyperplasia.

In terms of wound healing time, the wound healing time of the control group was (49.0±15.1) d, and the healing time of the alginate dressing group was (28.6±10.5) d. The difference between the two groups was significant ( P < 0.05).

In terms of local inflammatory reaction, when the alginate dressing is changed two or three days after the first use of the difficult-to-heal wound, most or all of it can be seen to be degraded, and there is still a small amount of secretion from the wound. However, after the application of alginate After applying salt dressing for an average of (4.2±0.6) days, the redness and swelling around the wound subsided, the inflammatory reaction was alleviated, and the secretions were significantly reduced. In the control group, the redness and swelling around the wound subsided after an average of (10.2±1.8) days of dressing change, and there was a significant difference between the two groups. significance (P < 0.05).

In terms of the effect on the skin quality after healing of difficult-to-heal wounds, after using alginate dressing on difficult-to-heal wounds, the healing effect is compared with the healed wounds in the control group. The wound surface is smoother and flatter, with lighter pigmentation and blisters. and reduced residual wound formation. Follow-up within 12 months after the two groups of cases healed found that 5 cases in the alginate dressing group (30 cases) developed hypertrophic scars, with an occurrence rate of 16.7%; 17 cases in the control group (30 cases) developed hypertrophic scars, with an incidence rate of 16.7%. The rate was 56.7%, and the difference between the two groups was significant (P<0.01). Some cases in the control group even developed keloids.

We believe that in this study, the reason why alginate dressing can effectively promote the healing of refractory burn wounds is attributed to the characteristics of alginate dressing. After covering the wound, the alginate dressing comes into contact with the wound exudate. Through ion exchange, the insoluble calcium alginate is changed into soluble sodium alginate, and calcium ions are released at the same time. It can absorb 20 times the amount of exudate of its own weight (5~7 times that of gauze). times), after absorbing liquid, it expands into sodium alginate gel, forming a soft, moist, gel-like semi-solid material on the wound surface, which isolates the wound from the outside world, forming a sealed environment without atmospheric oxygen, accelerating the proliferation of new capillaries, It is of great significance to maintain a moist environment, improve the regeneration ability of epidermal cells, accelerate the movement of epidermal cells, and promote wound healing.

Moreover, alginate dressing has the following characteristics: ① Good air permeability, non-toxic, non-irritating, and non-antigenic. ② It has the functions of mechanical compression to stop bleeding and promote coagulation. ③It can reduce the loss of water, salt and nutrients from the wound surface. ④Restrict the growth and reproduction of bacteria on the wound surface. ⑤ Keep the wound in a moist environment, which is conducive to epithelial growth.

From the observation results of this study, it can be seen that alginate dressing can significantly shorten the healing days of difficult-to-heal wounds after burns, reduce local inflammatory reactions, and improve the quality of wound healing compared with traditional Vaseline gauze. The application of alginate dressings greatly reduces the average dressing change time and frequency, shortening the length of hospitalization of patients. Therefore, it not only relieves patients' pain but also reduces their treatment costs, and has broad application prospects.

However, there are currently not many studies on burn wounds, and less research data is available. There is still the possibility of biased results when drawing conclusions based solely on the data of this study. Therefore, more research is needed to confirm.

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