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Deep Second Degree Deep (DIID) Burns Wounds Treatment of BRT with MEBT/MEBO

The clinical signs of deep second-degree burns are similar to those of deep second-degree superficial burns, except that DIID has more serious injuries and more serious response during the liquefying period and therefore the reconstruction and regeneration of wounds become more complicated. 

The clinical treatment for deep second-degree burns also can be divided into four periods.

First Period. 

Clinical signs – no extensive blisters, epidermis entirely destroyed and adherent to injured dermis, the wounds free of putrid skin are no longer sensitive to pain, the wounds are white, with little exudate.

Some of the wounds may be red alternating with white, but the color-changing response to pressure is very slow. 

This period begins from the first day of burn through the 7th day postburn. During this period, simply apply MEBO to protect the wound.

Second Period. 

From day 7 to day 20 postburn, clear away all adhering substances to expose necrotic dermis and apply BRT with MEBT/MEBO immediately. For small wounds, simply use this treatment to liquefy and discharge the necrotic layer. 

For large burns, simple de-bridement should be used coordinately. The necrotic layer is so deep that the wound liquefying may be incomplete and cause lumps exfoliation of necrotic tissues, which need to be cut with surgical scissors and removed. 

Attention should be paid to keep a certain distance between the surviving viable tissue and the cutting. 

Any further damage to the surviving viable tissue such as bleeding (which may cause infection) should be absolutely avoided. 

Simple debridement can be adopted according to the condition of the wounds.

When the necrotic layer is almost completely liquefied, clean away the liquefaction products in time to ensure that the non-smooth survival tissue is kept in a MEBO environment, but not in an environment filled with liquefaction products.

Third Period. 

The period of reconstruction and regeneration of residual dermis tissue.

As little residual dermis tissue is left and the dermis frame is fundamentally destroyed, correct BRT with MEBT/MEBO is quite vital in this period. 

The reconstruction of dermis tissue involves three parts: 

(a) the reconstruction of vascular tree; 

(b) the reconstruction of fibrous tissue dependent on vascular tree;

(c) the regeneration of skin appendages, gland tissue, formation of excretory ducts, and formation of skin tissue. 

Any careless injuries and pressure to the wound are forbidden. This period usually happens on days 20–28 postburn.

Fourth Period. 

Aiming at helping the healed skin return to normal, the treatment in this period varies according to burns severity and skill in the treatment. 

The severe injuries to skin and the factors affecting the skin during reconstruction make the newly healed skin quite different from normal skin in structure, appearance and function. 

So the rehabilitation is very important, including two aspects: ‘protective therapy for healed skin’ and ‘functional exercise’. 

The former is accomplished by adjusting the structure of newly regeneration skin tissue with the application of MEBO Scar Lotion, by adjusting the function with MEBO Cleansing Cream, and by killing itch with MEBO Itching Reliever just after the wounds heal.

At early stage, the treatment is the same as that for deep second superficial type degree burns

Remove the necrotic skin 5 days later. 

Because the dermis layer has been injured, wounds appear wax-like white. 

Continue applying MEBO with the thickness of less than 1mm. Redress every 4 hours. 

After applying MEBO, there would be liquefied necrotic tissues exudates on wounds. 

It is a normal phenomenon and do not mistake it as infection

Remember to clean the residual drug and white liquefied exudates on wounds with disinfected gauze before redressing each time. 

About 15 days later, necrotic tissues are liquefied and discharged. 

Then a layer of fabric isolating membrane on wounds should form. 

Continue applying MEBO according to method mentioned above to protect the layer of membrane until wounds are healed with flat skin. 

If wounds are not healed after being treated for more than three weeks, it indicates that the wound is superficial third degree burn and should be treated with corresponding method.

1. After simple debridement, apply MEBO immediately to protect wounds.

mebt mebo deep second degree deep burns

2. On 5th day postburn, remove necrotic skin. Necrotic tissues on wounds are liquefied and discharged.

mebt mebo deep second degree deep burns

3. A layer of fabric isolating membrane forms on wounds under the action of MEBO.

mebt mebo deep second degree deep burns

4 . Apply MEBO complying with the principle of "Three No" (Don't cause pain, Don't cause bleeding and Don't cause any further damage in the normal skin tissue) and protect the membrane to promote repairing of wounds.

mebt mebo deep second degree deep burns

5. On 30th day postburn, burn wounds regenerate and repair.

mebt mebo deep second degree deep burns

6. Continue applying MEBO for 10-15 days to protect healed skin.

mebt mebo deep second degree deep burns

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