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Abstract

Objective: To compare clinical outcome of topical conventional with topical heparin treatment in 2nd degree or partial thickness (PTB) burn patients. Methods: Patients, between the ages of 14 and 60 years with 2nd degree burns involving <20%. Total body surface area (TBSA) on front of chest, abdomen and upper limbs excluding hands and lower limbs were enrolled from September 2015 to August 2016. Patients were randomized to conventional or heparin treatment groups. Clinical outcome measured were healed wound size, pain scores and total consumption of analgesic medication required to relieve pain. Safety of the treatment and adverse events were also measured RESULTS: Out of 66 patient included in study mean (SD) age of participants was 27 (10) years, of which 59% were males. Mean (SD) TBSA burn was 14% (3) [23 (35%) had SPTB, and 43 (65%) had DPTB]. The burn injury was caused by flames in 68% and by hot liquids in 32% patients. There was no statistically significant difference in distribution of patients according to age, gender, TBSA burn, etiology or depth of burns in the two treatment groups. As compared to conventional treatment group, heparin treatment group had significantly better outcomes. Number of days needed for wound healing was significantly lower in the heparin group than the conventional group (SPTB 14±1 vs. 20±4 days; P-value <0.000 and for DPTB, 15±3 vs. 19±2 days; P-value <0.003). Mean pain score was also lower in the heparin group (for both SPTB and DPTB 3±1 vs. 7±1; P-value <0.000). Similarly, total consumption of analgesic medication was significantly less in the heparin group (53±27 vs. 119±15mg; P-value <0.000 for SPTB and 46±6 vs. 126±12mg; P-value <0.000 for DPTB). In both groups, no patient had wound infection, skin necrosis, leucopenia, thrombocytopenia, worsening renal function, or abnormal liver enzymes CONCLUSION: Treatment of second degree or partial thickness burns (PTB) with topical heparin is superior to conventional treatment in terms of wound healing as well as for pain control. The treatment with topical heparin is well-tolerated and is without higher adverse effects.

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... Manzoor et al., randomized controlled clinical trial compared topical conventional treatments (including Polymyxin B sulphate, Bacitracin Zinc and Sulphadiazine 1% cream) with topical heparin treatment in partial thickness burn patients in the whole body [18]. ...
... This study found that heparin therapy was associated with faster healing of the partial thickness burns, as evidenced by the wound size, number of wounds healed, or days needed to heal. This effect was also associated with less skin discoloration, pseudo-eschar formation and skin allergy [18]. ...
... In Manzoor et al., the significant effect of heparin in wound healing was explained by its chemotactic effect on endothelial cells, with resultant stimulation of neovascularization and improvement of blood circulation subjacent to the burn. In partial thickness burns, the deeper layers of skin develop ischemic injury due to vasoconstriction mediated by local generation of compounds, such as thromboxane and possibly by vascular thrombosis within dermis [18]. Heparin has been shown to increase survival of deeper layers of skin through its vasodilator and anti-thrombin effects, which prevents formation of new thrombi, and helps wash away the already formed thrombi [18]. ...
... Heparinase inhibition and adhesive molecule inhibition are two of the mechanisms involved in leukocyte recruitment into tissues [12]. Heparin has anti-allergenic, anti-histaminic, anti-serotonin, analgesic, and anti-proteolytic characters [13]. Heparin's analgesic action could be related to its ability to block pro-inflammatory chemicals that act on nerve endings [13,14]. ...
... Heparin has anti-allergenic, anti-histaminic, anti-serotonin, analgesic, and anti-proteolytic characters [13]. Heparin's analgesic action could be related to its ability to block pro-inflammatory chemicals that act on nerve endings [13,14]. ...
... The sample size was calculated using the healing time differences reported by Manzoor S et al in heparin and conventional dressing groups of burns patients as 14 ± 1 days 20 ± 4 days (43). The minimum required sample size was calculated to be 8 at 95% con dence level and 80% power. ...
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Background All wounds that cannot be closed primarily needs skin coverage earliest to prevent form infections. Skin graft provides earliest and easiest wound coverage, but produces another wound, i.e. donor site wound. This study is conducted to see healing time efficacy of topical heparin spray versus conventional dressing in healing donor site wounds. METHODOLOGY The study was designed as a single center, prospective, randomized control trial study. It was conducted in the Department of Plastic and Reconstructive Surgery at Civil Hospital Karachi. The study was carried out for 10 months of the period from Sep 2020 to July 2021. The sample was calculated by using OpenEpi version 3.01.The minimum sample size was calculated to be 8 at 95% confidence level and 80% power, though the study included 60 patients who underwent split thickness skin grafting for healthy granulating wounds. From the next day of surgery heparin dressing and conventional dressings groups were made and dressing was done daily till seventh postoperative day. Data in form of questionnaire and photographic assessment was recorded filled at every change of dressing. This study was a self-controlled trial, therefore every trial participant served as his/her own control. Data was analyzed by using Statistical Package for Social Sciences (SPSS version 24). RESULT The results of the analysis showed the mean age of the participants was (35.30 ± 8.87). Male gender predominated with a frequency of 82% while females were 18%. A decrease in soakage of dressing was recorded in 48 (98.0%) male participants at interventional half; however, all females experienced no difference at both dressing sites. Similarly 48 (98.0%) male participants a reduction in itching at intervention site and all females had experienced no difference in itching at both dressing sites. In regard to wound size, 40% of participants showed a reduction in wound size and only 20% showed no improvement at interventional half. During 7days, 81.67% of participants showed improvement in edema at intervention half and 96.7% of participants reported no change in edema with conventional therapy. None of the participants scored worst pain at the intervention area. CONCLUSION The study showed heparin irrigation result in better wound healing and significantly reduces pain, edema, enhances faster healing and reduces soakage of dressings. Trial registration The study was approved by Institutional Review Board of Dow University of Health Sciences and was registered at Clinical Trials.gov (ID: NCT04613336).
... Cleaning, cooling with flowing water or a cold compress, applying a topical agent, donning a sterile dressing, and restoring full function are all effective treatments for second-degree burns. Topical medications such as povidine iodine and topical heparin are also effective in the heal burns (2,4,5). Hence, it is imperative to advance innovative methodologies or treatments that not only halt the progression of burn wound infections but also potentially accelerate wound recovery while mitigating adverse effects. ...
Article
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Agarwood leaves (Aquilaria malaccensis Lam.) contain chemical substances such as alkaloids, flavonoids, and triterpenoids that contribute to the healing process of burns. This study aims to evaluate the wound healing activity of spray-dried extract from agarwood leaves formulated into an ointment for second-degree burns. The method involves extracting agarwood leaves through the decoction method, followed by spray drying, and subsequent evaluation of the extract. The prepared extract was then formulated into an ointment and tested for wound healing activity on 24 white rats of the Sprague-Dawley strain, divided into four groups, each consisting of 6 rats: negative control (ointment base), positive control (Betadine®), formula 1 (agarwood leaves extract ointment with 20% extract concentration - ALO-20), and formula 2 (agarwood leaves extract ointment with 30% extract concentration - ALO-30). Second-degree burns were induced by exposing the rats' backs to ferrous metal for 3 seconds and treating them for 14 days. Observations were made by assessing changes in burn diameter and scab formation. In this study, ALO-30 demonstrated superior activity. Scab formation was faster on day 3, and the burn diameter was reduced by day 7. The results indicated that ALO-30 led to a quicker reduction in wound diameter compared to ALO-20 and the negative control. Agarwood leaves extract ointment with a concentration of 30% (ALO-30) exhibited a more effective wound healing effect than the ointment with a 20% concentration (ALO-20).
... Similarly, Manzoor and his team suggested topical treatment with heparin showed significantly superior results compared to conventional treatment (silver-based ointment) in the management of partial and second (deep) degree thickness burn. It is believed that heparin is well tolerated in patients without any serious adverse effects [127]. Further, new research is needed to explore the heparin composite biomaterials as a skin substitute in dermal regeneration and wound healing applications. ...
Article
In the last few decades, the development of biocompatible polymeric materials for biomedical applications has advanced significantly, which is of utmost necessity for skin regeneration and wound management. Nowadays, natural and synthetic based polymers are more favorable in the management of wound care and possess encouraging properties compared to conventional treatment which include grafting (autografts, allografts and xenografts), but due to its limitations such as lack of skin donor sites, immune rejection and immunological response, thus not act as an appropriate skin substitute in dermal regeneration. The current review highlights the recent advancement in the field of biopolymeric materials (single or in combination) and the various types of dressings used in dermal regeneration and wound management. Moreover, we also summarise the various biopolymer materials accompanying its commercially available wound dressings, their uniqueness, advantages, and disadvantages, and suggest how to overcome the problems associated with individual biopolymers and produce a perfect wound dressing with superior mechanical and cellular characteristics. This review will provide current knowledge in the research of biomaterials used for dermal regeneration and in wound management, including their limitations. We also believed that understanding the correctness of biomaterials for skin regeneration would enable us to provide the best wound dressings based on their specific applications.
... Furthermore, epithelization by the proliferation of these surviving de-epithelized island cells is induced with heparin thus making superficial and deep burns heal in a shorter period of time [11,12]. Manzoor et al., [13] also found similar results. In current study observed that no (0%) patient was found with wound infection in group A and 1(4.8%) patient was found with wound infection in group B. The difference was not statistically significant (p>0.05) between the two groups. ...
Article
Introduction: Burn is a complex disease process, a trauma to physique as well as psyche. Visible disfigurement caused by burns translates into an altered pattern of socialization which in turn can have serious psychological ramifications. Patients with burns require immediate specialized care in order to minimize morbidity and mortality. So, the important part of the management of burns is wound management. Objectives: To assess the efficacy of topical heparin and silver sulfadiazine cream in burn wound management. Methods: Prospective comparative interventional study was carried out at the Department of Burn & Reconstructive Surgery, Faculty of Paedicatric Surgery, Bangladesh Shishu Hospital and Institute. A total 42 patients were included in this study after fulfilment of all selection criteria during the study period. Patients were randomly selected into two groups. In group A (n=21) patients were treated with topical heparin and in group B (n=21) patients were treated with silver sulfadiazine cream. Results: The mean pain relief time was 1.76±0.54 days in group A and 5.52±0.98 days in group B. The difference was statistically significant (p<0.05). The mean wound healing time was 4.62±0.86 days in group A and 8.0±1.97 days in group B. The difference was statistically significant (p<0.05). The mean hospital stay was 5.57±0.75 days in group A and 8.10±1.97 days in group B. The difference was statistically significant (p<0.05). Conclusion: Topical use of heparin is safe and more effective than silver sulfadiazine cream in the management of second-degree burns in children.
... Multiple local drugs were used to enhance donor area healing such as platelet-rich plasma (PRP) [3] and heparin [4]. On the other hand, systemic application of insulin-as an anabolic hormone-has a positive effect on all phases of wounds healing. ...
... When VAS scale on day 1 and day 7 were observed in both groups of our study, the control group was observed with much higher VAS values as compared to Heparin group on day 7 (i.e.7.71±1.58 in control vs. 3.15±0.92 in heparin group) and the difference was statistically highly significant (p<0.05). Sobia Manzoor et al, [15] found mean pain score was also lower in the heparin group (3 ± 1 in heparin vs. 7 ± 1 in control group). ...
Article
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Background: Heparin is a multifaceted compound with uses not only as an anticoagulant, but also as an anti-inflammatory, anti-allergenic, anti-histaminic, anti-serotonin, anti-proteolytic and neoangiogenic agent. The aim of the study was to study the effect of topical heparin in the management of burns in terms of morbidity, mortality & safety. Subjects and Methods: A hospital based RCT with total duration of 16 months from June, 2018 to September, 2019 with 100 patients (age between 15-45 years, burns from 20-60%, with less than 48 hours duration), randomly enrolled into 2 groups, after initial resuscitative measures, 50 cases receiving Topical Heparin treatment, 50 controls receiving conventional treatment (1% silver sulphadiazine) with i.v. antibiotics, after explaining the study objectives and taking informed written consent. Data analysis was performed using Epi Info software. Results: Patients treated with topical heparin experienced statistically significant (p<0.05) improved pain relief, rapid healing, lesser complications and reduced duration of hospital stays. Conclusion: The current study demonstrates that topical heparin can improve clinical outcomes in the treatment of burn injury.
Article
Healing of a wound is a multifaceted process that involves several factors to be considered for proper completion. Improper healing of wounds is a widespread phenomenon that affects millions of people across the world constantly. Treatment of acute or chronic diabetic wounds has been one of the major clinical challenges past several years as diabetic patients have much more deprived wound healing which often leads to surgery of the injured site or amputation of the wounded part is usually done in severe cases. Angiogenesis plays a major role in the process of neovascularization, so angiogenesis is a potential target for wound healing as the newer blood vessels formed over the injured surface are important to provide nutrients, immune cells, and oxygen for the healing of wounds. Several classes of drugs act on different growth factors for treating certain disorders and these drugs can be repurposed for the healing of different types of wounds. A vast literature survey was carried out to find potential drugs that can be repurposed for the healing of wounds. Repurposing of drugs is economical compared to that of traditional treatment methods and it can be delivered to a wider range of people in need. These drugs might have the potential to initiate the neovascularization development through angiogenesis which aids the accelerated wound healing process. Wound healing is a complex multistep process that involves several cellular infiltrations and their subsequent physiological actions. Angiogenesis is the process of new blood vessel formation and it is helpful in wound healing as the newer blood vessels formed at the injured site are important to provide nutrients, immune cells, and oxygen for the healing of wounds. Growth factors play a major role in initiating the angiogenesis process and several drugs act on these specific growth factors directly or indirectly which can be repurposed to activate angiogenesis and accelerate the healing of different types of wounds (burns, diabetic ulcers, and trauma wounds). These classes of drugs will be screened for their binding affinity with the target growth factors using the in-silico docking software (PyRx and Autodock Vina). The drug classes will be further suspected to in vitro studies (Ex., scratch assay, and trans-well migration assay) and followed by in vivo wound healing studies on animals. Artificial intelligence technology helps with drug relocation by cutting expenses and time even further. New computational techniques for identifying connections between many kinds of biological entities, including genes, proteins, and medications, can be advantageous for drug repurposing. So, this will benefit the research in finding, repurposing, and developing new therapeutic ways for wound care medications that are already on the market. It will also be used to keep track of the wound healing progress across a community.
Article
Background: Burn damage to skin often results in scarring; however in some individuals the failure of normal wound-healing processes results in excessive scar tissue formation, termed 'hypertrophic scarring'. The most commonly used method for the prevention and treatment of hypertrophic scarring is pressure-garment therapy (PGT). PGT is considered standard care globally; however, there is continued uncertainty around its effectiveness. Objectives: To evaluate the benefits and harms of pressure-garment therapy for the prevention of hypertrophic scarring after burn injury. Search methods: We used standard, extensive Cochrane search methods. We searched CENTRAL, MEDLINE, Embase, two other databases, and two trials registers on 8 June 2023 with reference checking, citation searching, and contact with study authors to identify additional studies. Selection criteria: We included randomised controlled trials (RCTs) comparing PGT (alone or in combination with other scar-management therapies) with scar management therapies not including PGT, or comparing different PGT pressures or different types of PGT. Data collection and analysis: At least two review authors independently selected trials for inclusion using predetermined inclusion criteria, extracted data, and assessed risk of bias using the Cochrane RoB 1 tool. We assessed the certainty of evidence using GRADE. Main results: We included 15 studies in this review (1179 participants), 14 of which (1057 participants) presented useable data. The sample size of included studies ranged from 17 to 159 participants. Most studies included both adults and children. Eight studies compared a pressure garment (with or without another scar management therapy) with scar management therapy alone, five studies compared the same pressure garment at a higher pressure versus a lower pressure, and two studies compared two different types of pressure garments. Studies used a variety of pressure garments (e.g. in-house manufactured or a commercial brand). Types of scar management therapies included were lanolin massage, topical silicone gel, silicone sheet/dressing, and heparin sodium ointment. Meta-analysis was not possible as there was significant clinical and methodological heterogeneity between studies. Main outcome measures were scar improvement assessed using the Vancouver Scar Scale (VSS) or the Patient and Observer Scar Assessment Scale (POSAS) (or both), pain, pruritus, quality of life, adverse events, and adherence to therapy. Studies additionally reported a further 14 outcomes, mostly individual scar parameters, some of which contributed to global scores on the VSS or POSAS. The amount of evidence for each individual outcome was limited. Most studies had a short follow-up, which may have affected results as the full effect of any therapy on scar healing may not be seen until around 18 months. PGT versus no treatment/lanolin We included five studies (378 participants). The evidence is very uncertain on whether PGT improves scars as assessed by the VSS compared with no treatment/lanolin. The evidence is also very uncertain for pain, pruritus, adverse events, and adherence. No study used the POSAS or assessed quality of life. One additional study (122 participants) did not report useable data. PGT versus silicone We included three studies (359 participants). The evidence is very uncertain on the effect of PGT compared with silicone, as assessed by the VSS and POSAS. The evidence is also very uncertain for pain, pruritus, quality of life, adverse events, adherence, and other scar parameters. It is possible that silicone may result in fewer adverse events or better adherence compared with PGT but this was also based on very low-certainty evidence. PGT plus silicone versus no treatment/lanolin We included two studies (200 participants). The evidence is very uncertain on whether PGT plus silicone improves scars as assessed by the VSS compared with no treatment/lanolin. The evidence is also very uncertain for pain, pruritus, and adverse events. No study used the POSAS or assessed quality of life or adherence. PGT plus silicone versus silicone We included three studies (359 participants). The evidence is very uncertain on the effect of PGT plus silicone compared with silicone, as assessed by the VSS and POSAS. The evidence is also very uncertain for pain, pruritus, quality of life, adverse events, and adherence. PGT plus scar management therapy including silicone versus scar management therapy including silicone We included one study (88 participants). The evidence is very uncertain on the effect of PGT plus scar management therapy including silicone versus scar management therapy including silicone, as assessed by the VSS and POSAS. The evidence is also very uncertain for pain, pruritus, quality of life, adverse events, and adherence. High-pressure versus low-pressure garments We included five studies (262 participants). The evidence is very uncertain on the effect of high pressure versus low pressure PGT on adverse events and adherence. No study used the VSS or the POSAS or assessed pain, pruritus, or quality of life. Different types of PGT (Caroskin Tricot + an adhesive silicone gel sheet versus Gecko Nanoplast (silicone gel bandage)) We included one study (60 participants). The evidence is very uncertain on the effect of Caroskin Tricot versus Gecko Nanoplast on the POSAS, pain, pruritus, and adverse events. The study did not use the VSS or assess quality of life or adherence. Different types of pressure garments (Jobst versus Tubigrip) We included one study (110 participants). The evidence is very uncertain on the adherence to either Jobst or Tubigrip. This study did not report any other outcomes. Authors' conclusions: There is insufficient evidence to recommend using either PGT or an alternative for preventing hypertrophic scarring after burn injury. PGT is already commonly used in practice and it is possible that continuing to do so may provide some benefit to some people. However, until more evidence becomes available, it may be appropriate to allow patient preference to guide therapy.
Article
Background: Human life is subject to certain environmental, cultural and ethnic origin factors. Based upon the above facts loose and tight variety of clothing/apparel are commonly used. Fire and flames are an integral part of human life on the other hand and accidents do occur in natural course of history. In such accidents type of apparel one might be wearing play a great role in degree or severity of burns. Association and assessments need to be established in this regard. Methods: The study has been conducted on 250 cases of dry flame burns in AED of Mayo Hospital Lahore/Medicolegal Clinic of King Edward Medical University Lahore for a period of nine months in 2017-18. The population of 250 cases were selected through convenient non-probability purposive sampling technique. The study descriptive cross-sectional study design was applied to the above population selected for the study. Results: Our study revealed1.6% females were involved more than males in the burn incident during the period of study. A wide majority up to 70% used Shalwar and Kameez of loose wearable category as per culture of the country in comparison to the relatively tight clothing of Trousers and Pantaloons variety. A grossly significant role has been established with a p value of 0.024 that loose variety of apparel are responsible for causing greater degree of damage in burns as compared to that of tight variety of apparel worn at the time of incidence. Conclusion: The study concludes that wearing relatively short apparels or of tight i.e. Trousers and Pantaloons variety can be safe, protective and a healthy habit during cooking, working in fire burning vicinity like that of industry, hotels, restaurants and winter outdoor activities. The loose variety hereafter referred as Shalwarand Kameezvariety of cultural apparels can be dangerous and even life threatening when it involves higher percentages of burns. Keywords: Burns, Apparel, Clothing, Degree of Burns
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Keeping abreast with current literature can be challenging, especially for practitioners caring for patients sustaining thermal or inhalation injury. Practitioners caring for patients with thermal injuries publish in a wide variety of journals, which further increases the complexity for those with resource limitations. Pharmacotherapy research continues to be a minority focus in primary literature. This review is a renewal of previous years’ work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Sixteen geographically dispersed, board-certified pharmacists participated in the review. A MeSH-based, filtered search returned 1,536 manuscripts over the previous 2-year period. After manual review and exclusions, only 98 (6.4%) manuscripts were determined to have a potential impact on current pharmacotherapy practices and included in the review. A summary of the 10 articles that scored highest are included in the review. Nearly half of the reviewed manuscripts were assessed to lack a significant impact on current practice. Despite an increase in published literature over the previous 2-year review, the focus and quality remain unchanged. There remains a need for investment in well-designed, high impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.
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In general, the systems intended for the treatment and recovery of wounds, seek to act as a coating for the damaged area, maintaining an adequate level of humidity, reducing pain, and preventing the invasion and proliferation of microorganisms. Although many of the systems that are currently on the market meet the purposes mentioned above, with the arrival of nanotechnology, it has sought to improve the performance of these coatings. The variety of nano-systems that have been proposed is very extensive, including the use of very different materials (natural or synthetic) ranging from polymers or lipids to systems derived from microorganisms. With the objective of improving the performance of the systems, seeking to combat several of the problems that arise in a wound, especially when it is chronic, these materials have been combined, giving rise to nanocomposites or scaffolds. In recent years, the interest in the development of systems for the treatment of wounds is notable, which is reflected in the increase in publications related to the subject. Therefore, this document presents generalities of systems involving nanocarriers, mentioning some examples of representative systems of each case.
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