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MEBO Dressing Change

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Contents

1. Skin 4. Dressing Change Method

Structure Exposed Method

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Function Semi-Exposed Method
Bandage Method

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Recovery Phase

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2. Burn 5. Combined Treatment
Causes Micro-Skin Implantation

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Degrees Bone Exposure
VAC

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TBSA

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3. Dressing Change Procedure 6. Systemic Treatment
First Degree Burn Fluid Resuscitation
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Second Degree Burn Anti-Infective Treatment
Third Degree Burn
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Skin

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 Skin Structure

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Skin Function

➢ Skin is the largest organ of the body.

➢ Function
• Protection: retain fluids，mechanical impact，ultraviolet light，foreign organisms.

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• Thermal regulation: sweat glands and blood vessels.

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• Sensation: heat, cold, pressure, contact and pain.
Endocrine: main sources of vitamin D.

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Burn

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 Causes of Burn

➢ Causes
Scalding from hot, boiling liquids

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• Chemical burns
• Electrical burns

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• Fires, including flames from candles & lighters
• Excessive sun exposure

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➢ Differences between countries

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• Mongolia-stove, boiling water

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• Philippines-electricity
• Western countries-sunburn, electric devices

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Degrees of Burn

Burn Degree Depth Appearance Sensation Healing Scar

1st Epidermis red mild pain 3-6 d -

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2nd Superficial Superficial Dermis red & blisters severe pain 1-3 wk unusual
(appendages intact)

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Deep Most Dermis white, dry waxy less painful ＞3 wk scar and contractures
(appendages destroyed )

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3rd Subcutaneous black or white, dry and no pain Does not heal severe scar and contractures
leathery

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Degrees of Burn
1st Degree Superficial 2nd Degree

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Deep 2nd Degree 3rd Degree

 Degrees of Burn

➢ First Degree(Ⅰ度)
granular cell layer of epidermis

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➢ Second Degree(Ⅱ度)
• Superficial Second Degree(浅Ⅱ度)

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basal cell layer of epidermis
• Deep Second Degree(深Ⅱ度 )

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✓ Deep Second Degree Superficial Type(浅型 )

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papillary layer of dermis
✓ Deep Second Degree Deep Type(深型)

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reticular layer of dermis

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➢ Third Degree(Ⅲ度)
• Superficial Third Degree(浅型) EB
superficial layer of subcutaneous layer
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• Deep Third Degree(深型)
deep layer of subcutaneous layer
Total Body Surface Area

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Dressing Change Procedure

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Dressing Change Procedure

First Degree Burn

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Dressing Change Procedure

Second Degree Burn

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Dressing Change Procedure

Second Degree Burn

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Dressing Change Procedure

Third Degree Burn

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➢ Combined Treatment
• Tension Relieving.
• Eschar Incision：remove 4/5 thinkness of eschar.
Dressing Change Procedure

Third Degree Burn

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 Skin Island

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Combined Treatment

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 Micro-Skin Implantation/Grafting

➢ Micro-skin Implantation
• Performed in OR or sterile room

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• Donor Site area: Graft Site area=1:20

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➢ After 4-6 weeks’ treatment, no sign of skin • Taken 0.15 mm-0.30 mm depth skin from donor site
island or only very few skin islands Cut into 0.5-1.0 mm granules

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➢ Granulation layer thickness ＞ 0.5 cm • Plant into granulation tissue
• Cover wound with 1-2 layers MEBO gauze and sterile

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gauze with slight pressure
Change dressing daily

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Bone Exposure

➢ Hole Drill

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• Drill hole on cortical bone till bleeding.
• Cover bone with MEBO.

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Vacuum Assisted Closure/Vacuum Sealing Drainage

➢ Advantages
• Draining excess fluid from the wound.

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Reducing swelling.

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• Reducing bacteria in the wound.
Keeping your wound moist and warm.

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• Helping draw together wound edges.
Increasing blood flow to your wound.

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• Decreasing redness and swelling (inflammation).

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Dressing Change Method

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Exposed Method

➢ Requirement
• T: 28-32 ℃ Clean Wound Apply MEBO

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• Humidity: 40-60%
Use dry sterile gauze to Smear 1mm thickness

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➢ Frequency absorb exudation and MEBO on wound.
• Every 4-6 hours

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MEBO residual.

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 Semi-Exposed Method

➢ Requirement

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• T: 28-32 ℃

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• Humidity: 40-60%

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➢ Frequency
• Every 8-12 hours

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Prepare MEBO Gauze Cover Wound

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Clean Wound
Squeeze sufficient Smear 1mm thickness
Remove Old Dressing

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Use dry sterile gauze MEBO on wound.
amount of MEBO on EB
Gently remove all old or forceps to gently
dry sterile gauze, mix Cover wound with 1-2
dressing. remove liquefaction
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until the gauze is fully layers of MEBO gauze.
and MEBO residual.
filled with MEBO.
Semi-Exposed Method

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 Bandage Method

➢ Frequency
• Every 12-24 hours

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Cover Wound

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Prepare MEBO Gauze Smear 2-3 mm thickness MEBO on
Clean Wound wound.

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Squeeze sufficient Remove Old Dressing Cover wound with 2-4 layers of
Use dry sterile gauze or
amount of MEBO on EB MEBO gauze.
Gently remove all old forceps to gently remove
dry sterile gauze, mix Cover wound with 1.5-3.0 cm
dressing. liquefaction and MEBO thickness cotton pad dressing.
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until the gauze is fully residual. Secure dressing with bandage and
filled with MEBO. tape.
 Bandage Method

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Recovery Phase

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➢ Apply MEBO for 10-14 days for protection and moisturization.

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➢ For deep Ⅱ & Ⅲ burns, apply MEBO scar product for 3-12 mths

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to prevent scar formation.

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 Key Points

➢ 1-ATTENTION
• Do not use sterile water, normal saline or any disinfectants to clean wound.

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➢ 2-EARLY

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• Early application (within 12 hours of injury) of MEBO.
• Early application of eschar incision and tension relieving techniques.

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➢ 3-NO

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• No pain, no bleeding and no damage to normal tissues during dressing change.

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➢ 4-TIMELY
• Timely remove liquefied metabolites, necrotic tissues and remnant MEBO.

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• Timely smear a new layer of MEBO.
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Systemic Treatment

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Anti-infective Treatment

➢ Routine Prophylactic Anti-infective Treatment

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• Adult: TBSA ＞30%; Pediatric: TBSA ＞10%
• Broad-spectrum high-potency antibiotics

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➢ Synergistic bacteriostatic effect of MEBO

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• Induce variation of bacteria: H-O variation

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• Decrease proliferation rate

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• Reduce bacterial pathogenicity
• Promote nonspecific immunity of body

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Fluid Resuscitation

➢ Oral Rehydration
• Adult: TBSA ＜20%; Pediatric: TBSA ＜10%

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➢ IV Rehydration
• First 24 hrs

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Total volume (ml/d) =physiologically required volume (ml)*＋TBSA (%) ×1ml×body weight (kg)

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e.g. 60kg, TBSA 80% patient→ 2000+80×60=6800 ml
*physiologically required volume=2000 ml

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After 24 hrs

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Total volume(ml/d)=physiologically required volume (ml)*＋TBSA(%)×1ml×body weight (kg)
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urine output (ml/h)/body weight (kg)*
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* normal urine output=1ml/h/kg

• Crystalloid solution: Colloid Solution= 1:1