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화상에 대하여[1][2][3][4]


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서론 | 대상및 방법 | 결과및 증례 | 고찰 | 결론 | 참고문헌



Moist Exposure Burn Therapy in Acute Burn Wounds

Dong-Chul Kim.MD.

Dr. Dong-Chul Kim's Aesthetic & Burn Plastic Clinic,
Institute of Plastic & Burn Surgery, Kangnam e Hospital

It is well known that the moist wound healing offers more proper wound condition, and more rapid epithelialization of skin than the dry wound healing. For the managements of acute burn wounds, also moist wound environments are reported for rapid repair & regeneration of skin. The moist exposure burn therapy, and various moist wound healing products were introduced. Among them, a ointment for moist exposure burn wound dressings is MEBO (moist exposure burn ointment), which had been developed at the Beijing Guangming Chinese Medicine Institute for burns, wounds & ulcers, Beijing, China. It's composed of B-sitosterol 5 mg%, sesame oil 15 mg%, yellow paraffin 80mg% etc.
I have experienced 8 cases of acute burn patient, who was managed by MEBT (moist exposure burn therapy) using MEBO ). The age range of patients were 17 to 62 year. The range of extent of burn were ranged from 1 % to 45%. The type of burn injuries were following that: 5 cases of scalding burns, 2 flame burns, and 1 electrical burn. The depths of burns were 2 superficial second degree burn, 2 mid dermal burns, and 3 mid to deep dermal burns, and 1 deep dermal to 3rd degree burns. Among them, 1 case of superficial second degree & all mid dermal burns, and 1 case of mid to deep dermal burn completely healed by burn dressing only. As a complication, at postburn 3 days, erythema & induration of surrounding normal skin of burn wound was noticed in 1 case of superficial second degree burn. And there was high spiking fever and marked leukopenia and thrombocytopenia were developed at post burn 4th day in a case of deep dermal to 3rd degree burn, 45%. These complicated cases were managed by Silvadene with closed burn dessings. On serial burn wound cultures, there were no growth in 6 cases. There were Aeromonas salmonicicda in 1 case, MRSA wound infection in 1 case.
It was noticeable markedly decreased pain of burn wound, and easy burn dressing changes. Also liquefied eschars were very easily removed day by day from 5 - 6th postburn days. In these series, the healing period of MEBT using MEBO ) were ranged by 10 days to 26 days. After follow ups of 2 weeks to 6 months, the healed burn area of MEBT using MEBO are revealed as relatively good in cosmetics & functions.



Key Word: Moist Exposure Burn Therapy, Acute burn, MEBO wound dressing


위 논문은 제 49차 대한성형외과학회 추계학술대회(2000년 11월 10일) 서울 워커힐 호텔에서 구연되었음.


서 론

창상치유에서 Moist-wound healing ( 습윤 창상치유)이 Dry-wound healing에 비해 Epithelial Repair Process가 더욱 촉진된다는 것이 알려졌으며, 즉 창상치유에 습윤창상치유환경(moist-wound healing environment) 이 창상치유(healing process)를 촉진하는 것이 알려졌으며,
따라서 급성 혹은 만성 창상 치료에 Calcium Arginate, Sodium Carboxymethylcellulose 등을 구성성분으로 하는 여러 습윤창상치유제재(moist wound healing products)들이 최근 소개되고 있으며 그 좋은 결과가 보고되고 있다.

또한 최근 급성화상의 창상치료에도 습윤 창상처치 시행후 좋은 결과가 소개되어지고 있다. 급성 화상의 창상 치료에서 MEBT(Moist Exposure Burn Therapy:화상습윤노출요법)는 고래로부터 사용되어온 방법으로 노출요법과 습윤창상치유의 개념이 있는 치료방법으로.
이 치료법은 화상창상을 노출시킨 후 화상연고제 등을 사용하여 습윤상태의 적절한 생리학적인 조건(physiologic condition)을 만들어 주면서 괴사된 조직의 용이한 제거, 창상의 재생(repair & regeneration)을 최적화 하는데 있다.
이때 이를 위해 고안된 습윤화상연고제를 사용하면서 화상창상의 습윤 환경을 유지하면서 화상창상의 치료를 하게된다.
저자는 2-3도의 급성 화상(acute burn) 환자에서 발생된 화상창상에 이러한 습윤화상치유제재로 알려진 MEBO ( moist exposed burn ointment)를 사용한 임상을 경험하여 그 치료 결과를 조사하여 보았다

 

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