Fire burns in combination with open fractures or exposed cortex of bones caused by Ⅲ degree burn are serious wounds commonly occurring in clinical practice. 

Direct debridement and suturing or skin flap transposition methods to close the wound can’t be adopted because of restrained conditions at local or whole damaged region. 

Skin graft cannot survive because of the deficient blood transportation supplied at basis. The dry necrosis of the exposed cortex of bone occurs commonly and this brings great difficulty in clinical treatment.

Method
1. For patients without fracture and with small area of exposed bone, the wound was debrided thoroughly and then was rinsed with 1/1000 chlorhexidine repeatedly. The foreign bodies and the necrotic tissues were removed and the living soft tissues were preserved as much as possible. MEBO was then spread onto the wound to cover the exposed cortex of bone with a thickness of 2 mm to 3 mm. The wound was bandaged with vaseline gauze and the wound dressing was changed once a day.

2. For patients with large area of exposed bone in combination with unstable fracture, fracture was first externally fixed using anchors, bolts or Kirschner pins with aseptic techniques. MEBT was used until the liquefaction and defluxion of all the necrotic tissues at the wound were realized. Pores were drilled on the exposed bone using hand drill with aseptic techniques until haemorrhage occurred. 

MEBO pressure dressing method was performed and wound dressing was changed once a day.

For systematic treatment, anti inflammatory treatment, symptomatic treatment and nutrient support treatment were adopted according to the concrete condition of burns complicated with other symptoms.

MEBO Scar Reducer was spread onto the proliferated scars after the wound healed with scar formation.

Discussion

Exposed cortex of bone caused by complex burn or large area of Ⅲ degree burns can not be closed with first intension because of restrained conditions at local or whole damaged region. The exposed tissues would be infected or dry necrosis would occur in the end. In case 1, the growth of the granulation tissue in the pores stopped although biological preparations that could promote the reparation of tissues such as Basic Fibroblast Growth Factor and Deproteinized Calf Blood Extractives were applied for the following reasons: the exposed wound and the cortex of bone was of dry necrosis; the wound basis was in short of nutrition support and conglutination supplied by vigorous tissues; there was deficiency of nutrient and water in the tissues. 

However, MEBO has the ability of promoting blood circulation to remove blood stasis, promoting the growth of new tissues and retrieving vitality with slough tissues discharged and accelerating the growth rate of tissues. The most important function of MEBO was that it could keep the tissues moist and prevent the dehydration of tissues, which protected the vigorous tissues at the wound maximally and prevented the dry necrosis of cortex of bone. It supplied anchors that were necessary for the growth of granulation tissues. 

In addition, pressure dressing treatment especially at the late growth stage of granulation tissues could prevent the edema and the excessive vertical growth of granulation tissues but promote the diffusive growth.

So it was favorable for the early closing of the lesion area.

Full Report:

MEBO Pressure Bandaging Method for Treating Bone Exposure, The Chinese Journal of Burns, Wounds and Surface Ulcers 2002(3): 172-174