A Study of Second Degree Burn Wound Healing With Topical Heparin Compared With Type I Collagen

Dhamodara Raj, V (2007) A Study of Second Degree Burn Wound Healing With Topical Heparin Compared With Type I Collagen. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Ever since man discovered fire, burns are among the oldest injuries man still suffers from. Since the days of Eber papyrus in ancient Egypt, the treatment of burns has advanced to the present day of skin substitutes. Autogenous skin remains the gold standard for burn would cover. But the paucity of available donor skin provided the impetus to look for materials that would provide temporary wound closure. During the recent past the use of biological and synthetic material in the temporary closure of the wound has become common place. During healing, the inflammatory phase is followed by the proliferative phase once the fibroblasts arrive and produce collagens, other proteins, glycosaminoglycans, the cells of tissue repair, and new capillaries in the granulation tissue. Thus, during the granulation tissue formation two major extra-cellular matrix proteins – collagen and proteoglycans play an important role. Though the efficacy of collagen and the heparin (a glycosaminoglycan) have been studied separately and found to be effective as against standard care with topical SSD, comparative study of burns treated with Heparin as a topical application and collagen have not been reported. In our 50 bedded critical burn centre at the Govt. Kilpauk Medical College Hospital, Chennai, where about 7000 outpatients of burns are treated with about 1600 in patients annually, the need was felt to evaluate the efficacy of topical heparin as against Type I collagen sheets in the management of partial thicken burns as a temporary dressing modality. AIM: To compare the outcome of partial thickness burns treated with topical heparin as against with collagen Type I to evaluate in each group the following: 1. Patient comfort with parameters like Pain, itching. 2. Healing time. 3. Length of stay in hospital. 4. The quality of the scar at the end of 6 months. 5. The cost benefit analysis. MATERIAL AND METHODS: Place of study - The study was done at Department of Burns and Plastic surgery, Govt. Kilpauk Medical College, Chennai – 600 010. Duration of Study - In the period between Jan 2005 to Jan 2006. Forty patients, with adults and children with second degree burns and scalds with TBSA burn 7% to 25% were recruited at random. They were allotted in to 3 separate treatment groups. Group A patients numbering 10 were treated with topical heparin in addition to the standard protocol burns management. The group B patients numbering 10 were treated with Healicoll™ (a Type I Collagen sheet preparation). Group C had 10 patients with symmetrical burns on either side who served as their own control with Heparin on one side and Collagen applied on other side.Thus making 20 burn wounds treatment with heparin and the other 20 burn wound treated with Type1 collagen. Inclusion Criteria: 1. TBSA burns size from 5% to 25%. 2. Partial Thickness (second degree) Burns. 3. Age from 1 year to 60 years. 4. Flame burns, scalds, steam burns were included. Exclusion Criteria: 1. Burns with TBSA more than 25%. 2. Patients aged more than 60 or less than 1 year . 3. Electric Burn. 4. I degree and full thickness burns. RESULTS: AGE - Children = 19, Adults = 11. Superficial second degree burns for the study were contributed by 66% paediatric patients defined as age below 12 years. Percentage of Burns - Of the above patients wherever the patient had symmetrical distribution on either side, the patients formed their own control group by application of heparin on one side and Type II Collagen Healicol on the other side. (n = 10). Majority of the study group consisted of accidental scalds in children (72% were scalds). It was noticed that heparin group epithelialised faster as the collagen group took more time to get separated. Two patients on topical heparin who developed mild wound infection took more time to heal. No case of bleeding was noted with 5000 IU/ml concentration of topical heparin. Type I collagen sheet remarkably had no infective complications. Heparin group patients were more cooperative for mobilisation due to less pain as against the collagen group who experienced pain and stiffness due to collagen drying up. Collagen group needed mild doses of chlorpheniramine maleate to alleviate mild pruritus. About 20% of collagen applicated wounds experienced mild itching at some point of time. Pink colour represented good scar. Red and purple scars were adviced compression garments to avoid Hypertrophic scar. CONCLUSION: 1. Topical Heparin in concentration of 5000 IU/ml per percent TBSA burns per day is safe and has no bleeding complications and needs no monitoring by BT, CT or PTT. 2. The final scar outcome with parameters such as scar itchiness, texture and pigmentation are favourable with topical heparin therapy. However the patient’s satisfaction level are same for both groups. 3. The wound infection rate is less with collagen sheet dressing when compared to topical heparin. 4. Hospitalization and patient discomfort, technical labour required are all significantly high with topical heparin. May be concluded that Type I collagen sheet dressing is preferable to heparin dressing in a large burn centre such as KMC in view of faster patient turnover, lower infection rate, ease of management and single application time, significantly reduced hospital stay and comparable patient satisfaction level of final scar outcome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Second Degree Burn Wound Healing ; Topical Heparin ; Comparision ; Type I Collagen.
Subjects: MEDICAL > Plastic and Reconstructive Surgery
Depositing User: Kambaraman B
Date Deposited: 12 Oct 2017 01:57
Last Modified: 12 Oct 2017 01:57
URI: http://repository-tnmgrmu.ac.in/id/eprint/3569

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