guidance on application of mebo wound ointment.docx

7/15/2019 Guidance on Application of MEBO Wound Ointment.docx

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ance on Application of MEBO Wound Ointment

Discretion: The section contains discretional information and is intended for medical professionals only]

ng instructions illustrated the standard practice and outcomes experienced in MEBO treatment. For the investigational us

ease refer to specific clinical study protocol where the clinical procedures are specifically defined and standardized.

MEBO Application in 1st Degree Burns

1. First degree burn: skin redness, slight swelling andpainful.

2. Apply MEBO immediately after injury. With theabsorption of MEBO, pain is relieved and edema isdiminished gradually. Skin color may return to normalin 12 hours. Continue applying MEBO 2-3 times a day.

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3. Burned skin would heal in 2-4 days. Continueapplying MEBO as a protective ointment for about oneweek. For burns with edema, the epidermis is partiallydestroyed, the pain may be relieved slowly and thecornified layer of skin exfoliates.

MEBO Application in Superficial 2nd Degree Burns

1. Apply MEBO tothe wound at 0.5-1mm in thickness;puncture the blister(if present) on thelower part todischarge liquid,retain the blisterskin un-removed;

apply MEBO on theblister skin 3-4times daily.

2. In 3-4 days, the

blister skin isloosened andexfoliated; gentlyremove and cleanaway the blisterskin, then applyMEBO immediately.



3. A thin layer of clear exudate maybe seen on thewound bed. Do notneed to remove. Do

not mistreat it asinfection.

4. During the woundcleaning andreapplying MEBO,avoid causing painor further injury to

wounds. SmearMEBO in thedirection along withfine hairs to avoidstimulations.

5. Alternatively,sterile gauze couldbe used to absorbthe liquefiedexudates for 30seconds -1 minute.

6. Gently remove

the gauze in atangential directionto avoid causingpain and injury to

the wound.



7. Clean theexudates completelybefore eachredressing withMEBO.

8. Evenly applyMEBO on thecleaned wound by0.5-1 mm inthickness.

9. Wounds wouldheal in 6-8 days.Continuously applyMEBO as aprotection for about7-10 days until skinfunctions are fullyrestored.

MEBO Application in Deep 2nd Degree-Superficial Subtype Burns



a. Burn wounds of superficial 2nd degree burnsmixed with deep 2nddegree-superficial subtype burns onthe 1st day after injury.Puncturing the blister and

discharge the liquid withoutremoving the blister skin.

b. Applied MEBO directly tothe wounds.

c. On day 3. Edemagradually diminishes; ayellowish thin membraneusually forms on the woundsurface. The membrane stillallows the underlyingexudates oozing through.Protect this layer when

clean up the wound, since itcan temperately protectwound.



d. On day 4, superficial2nd degree burn woundshas started to heal.Meanwhile, necrotic tissuesof deep 2nddegree-superficial subtype burns

on waist and back areliquefied. Redressing MEBOevery 4 hrs in daytime andevery 6-8 hrs in nighttime. Remove the thinmembrane.

e. On day 8, the wounds of superficial 2nd degree burnwounds has been healedcompletely. The wounds of deep 2nddegree-superficialsubtype burns have beentotally liquefied. Removed

the loosened or exfoliatedblister skin.

f. Enlarged view of the8thday after burn.



g. On day 12, most of thenecrotic tissues on deep2nd degree-superficialsubtype burns have beenliquefied and discharged.There is a thin fiber

membrane formed on thewounds and the woundshave started to heal.

h. On day 15, mostwounds have been healed.

i. On day 25, all woundshave been completelyhealed. Continue applyingMEBO as a protection tonew skin for 10-15 daysuntil the skin functions arefully restored.

MEBO Application in Deep 2n Degree-Deep Subtype Burns



1. After simpledebridement,immediately applyMEBO to protect thewounds, and redressMEBO by the same

procedure describedinsuperficial subtype.

2. On 5th – 7th day

postburn, gentlyremove the blister skin.Necrotic tissues start tobe liquefied anddischarged. A thin softfiber membrane isformed on the woundunder the actions of MEBO. Continueapplying MEBO andprotect the thin softmembrane.



3. On the 20th daypostburn, woundhealed withregenerated skin.

4. Continue applyingMEBO as a protectionfor 10-15 days. Hypo-

pigmentation is noted.

MEBO Application in Superficial 3rd Degree Burns



a. Patient with facial burns afterexposure to flame. No painsensation, no exudates areobserved.

b. Histological examination of

burn wounds shows full-thickness burn injuries.

c. Perform ‘wound ploughing’ with a specially designed ‘sawtooth cutter’ on burnwounds in the early stage torelease tensive pressure onunderlying vital tissues. Ploughdry and leathery skin till minorbleeding.



d. Apply MEBO directly to the ‘ploughed’ wounds.

e. On day 2, after cleaning theburn wounds, repeat ‘woundploughing’ till minor bleeding on

wound. Redress MEBO every 4-6 hrs.

f. On day 12, a typical view of the liquefaction process of necrotic tissues. Do not mistreatthis process as wound infection.



g. On day 18, the necrotictissues are mostly liquefied andpainlessly discharged;meanwhile the subcutaneoustissues are promoted to grow.

h. On day 27, some burnwounds have been healed withregenerated tissues while otherburn lesions are going throughhealing process.

i. On day 50, most burn woundshealed with physiologicallyregenerated new skin. Note thesymmetrical smile; no scarringon face; full sensationrecovered.



j. On day 72, all wounds havebeen functionally healed.

MEBO Application in Deep 3rd Degree Burns

1. The patient has 85%TBSA 3rd degree burns.Wound pathological exam

shows full thicknessnecrosis (fig a, b, c).



2. ‘Wound ploughing’ isperformed for relievingpressure on underlyingtissues by using speciallydesigned ‘sawtooth cutter’,followed by MEBO

application.

3. Clean up theliquefied necrotic

tissues before

redressing MEBO.The pathologicalsection shows new

skin structure has

been rebuilding onday 20. (fig e, f)



4. On day 25,

numerous ‘skinislands’ have

emerged fromregenerated skin

tissues.

5. In the ‘skinisland’,

regenerative cells

from subcutaneoustissue are robustlymultiplying. Note

capillaries,collagen, and

epithelial cells.

6. ‘Skin islands’ gradually extend and

merger together.



7. On day 49,regenerated skinexhibits the normal skinstructure in pathologicalslide.

8. On day 72, burnwounds have beenhealed completely withregenerated skin.

MEBO Application in 4th Degree Burns



a. Appearance of burned tibia of left leg.

b. Surgical excision of thenecrotic tissues on bone surface.

c. Removal of the necroticperiosteum and outer cortex of tibia with scraper and bonechisel.

d. Multiple holes drilled on theexposed tibia surface in 1.0 cmapart; deep to viable marrowcavity; minor bleeding isexpected.



e. Appearance of tibial surfaceafter drilling.

f. Subsequent to the application

of preserved gauze soaked withMEBO to cover the wound; smallgranulating buds grew upthrough the drilled holes withinfew days.

g. Continuous treatment withMEBO, the granulated tissuesdeveloped and spread to form agranulated wound. Skin graftingwas then performed to close thewound.

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