You are on page 1of 18

Effects of Topical Heparinization of the burn wound ; Pilot study 4 cases presentation

By; Dr. E. El-Tayeb

On studying the pathophysiology of the local burn injury ; micro-thrombi whatever it’s etiology converts the zone of stasis to a zone of coagulation making the

Heparin sodium inhibits reactions that lead to the clotting of blood and the formation of fibrin clots both in vitro and in vivo. Heparin acts at multiple sites in the normal coagulation system. Heparin sodium also prevents the formation of a stable fibrin clot by inhibiting the activation of the fibrin stabilizing factor.

Heparin sodium does not have fibrinolytic activity; therefore, it will not lyse existing clots.

topical and parenteral use of heparin in burnt patient produce significant therapeutic results;

Relieve pain,  Enhance healing,

decrease resuscitation fluids, decrease lung and intestinal complications. (Saliba M.J 1967-70-74
/Mangus D.J., Falces E., Gilchrist D.R )

many burn & non-burn studies revealed & confirmed, that heparin had anti-inflammatory effects (Carr J 1979 )

neoangiogenic, (Azizkhlan R.G
1980/ Macaig T. et al 1984) (Ramakrishnan K.M et al 2000)

collagen-restoring,

And epithelializing effects (McCarthy D.W / Ehrlich H.R 1986) in addition to its anticoagulating effects.

Heparin is a heterogeneous group of straight-chain anionic mucopolysaccharides, called glycosaminoglycans having anticoagulant properties. Heparin Sodium Injection is a sterile solution of heparin sodium derived from porcine intestinal mucosa, standardized for anticoagulant activity.

A pilot study of 4 cases with deep dermal burns ( comparatively with symmetrical burn sites in each patient )  8 years old child with 9% scalding at the both feet & lower legs . The pt. presented to the burn unit 3 hours after injury.  24 years old man with 11% hot tar burn at both feet, lower legs . The pt. presented to the burn unit 1 hour after injury.  38 years old female with 6% scalding at both hands & forearms The pt. presented to the burn unit 5 hours after injury.  32 years old baker with 14% flame burn at both hands, lower forearms and face . The pt. presented to the burn unit 2 hours after injury.

These 4 patients selected from many patients considering :  Symmetrical areas of injury.  age of the patients.  Multiple types of famous burns .  All patients considered as minor burns ( all didn’t receive any fluids ).  Early transfer of the pt.

1st aid measures were done for all patients  1st child dressed with heparinized nitrofurazone ( as a soluble dressing) to the rt. Side & nitrofurazone only for the lt. side .(closed)  2nd man with hot tar burn dressed with heparinized silver sulphadiazine for the rt. Side & only silver sulphadiazine for the lt. Side. (closed)

3rd female was dressed with heparinized povidine iodine for the rt. Side & povidine iodine only for the lt. Side. (closed) 4th man was heparinized nitrofurazone to the Rt. Side & nitrofurazone only for the lt. side. (closed) ; face treated by open technique.

Heparinization of the wound estimated as ( each 1% BSA needs 1 ampoule of heparin sodium 5,000 IU/ml for about 10 gm of antiseptic ointment .) application of Such heparinized dressing was for three times daily to prevent wound dryness; The non-heparinized part is also dressed 3 times .

All patients received oral antibiotics & the medical treatment for the minor burns. All 4 patients admitted to the burn dept. to be closely followed up.

The preliminary results for the patients .
Early healing of the heparinized part significantly faster than the non-heparinized one.  less incidence ( after short term follow up ) of itching & hyperemia in the heparinized part .

Healing time for the h.part

Healing time for the non h.part

1st pt. 2nd pt.

7 days 11 days

9 days 16 days

3rd pt.

10 days

11 days

4th pt.

10 days

13 days

Recommendations
Further research should longitudinally compare the performance of heparinized & non heparinized dressing regarding these items • healing time • early post healing problems itching & hyperemia • late post healing problems like hypertrophic scarring ,keloids & ugly scars