INTERNATIONAL JOURNAL OF COSMETIC SURGERY and AESTHETIC DERMATOLOGYVolume 2 Number 1 2000Mary Ann Liebert Inc

Clinical Use of MEBO in Wounds Management in UAE

ALI AL-NUMAIRY MD FICS

ABSTRACT

Wound healing is complex and wound dressings are an integral part of the healing processCovered wounds heal more quickly than open wounds We have used moist exposed burnointment (MEBO) in an attempt to evaluate its efficacy This study showed MEBO is safe ef-fective and shortens the time of treatment as well as reducing the chance of wound infec-tion resulting in very good overall aesthetic results

27

INTRODUCTION

WOUND HEALING is complex and methodsof wound management have been chang-

ing because of recent scientific advancementsThe origins of open slow-healing wounds in-clude extrinsic factors such as acute or chronicmechanical causes physical or chemical burnsfrostbite infections or toxins whereas intrinsicfactors include congenital genetic vascularautoimmune neoplastic or psychosomaticThere is now a better understanding of themechanisms of wound healing

The problems of infection were solved by theobservations of Fleming(1) but healing prob-lems are among the major cause of disabilitydeformity and death(2) The morbid effects ofwound healing are prevented by early resur-facing or re-epithelialization Wound healing isaffected by the patient the wound and cells inthe wound with overlapping problems of mi-crocirculation local immunity and dressingmethod (Fig 1) The desired result is healingwith minimal scar and no functional defect

Wounds may be managed in metropolitan orrural areas and therefore personnel at all facil-ities should be well informed about recent ad-vances in the physiology and pathology of

healing in order to practice optimal woundcare Proper wound care is time-consumingand may require irrigation scrubbing approx-imation of wound edges with suturing or tap-ing and other materials or methods Recentstudies have shown alternative methods ofwound closure without needle and sutures(3ndash5)

Different types of dressings are used to protectthe wound from the external environment inorder to enhance healing and research hasshown the value of tissue growth factors to ac-celerate healing(6ndash12) Dressings may be dry ormoist and open or closed using biological orsynthetic material

Crusted wounds epithelialized more slowlythan covered wounds(13) All dressing materi-als have some protective barrier propertieswhile a moist wound environment helps tokeep cells viable enables them to releasegrowth factors modulate and stimulate theirproliferation and promote cell migration(14)

Enzymes such as collagenases and proteasesenable cells to migrate across the wound inmoist areas where fibrin is deposited thus pro-moting healing

Moist exposed burn treatment (MEBT) in usein China since the early 1980s (Rongxiang Xupersonal communication 1996) provides the

Director Gulf Plastic Surgery Center Dubai United Arab Emirates

FIG 1 Wound healing is the result of three factors thepatient the wound and cells involved Each affects andis affected by the other

AL-NUMAIRY28

FIG 3 A Scald burn of the anterior chest upper abdom-inal wall and left axilla 3 weeks previously When the childwas an inpatient the family was advised to proceed withskin grafting but refused He was treated with a conven-tional dressing as an outpatient The patient was seen in myprivate practice where after 3 weeks the burn still had adeep slough The wounds looked to be deep partial thick-ness with areas of full thickness burn The patient wastreated conservatively by MEBO (12 hourly) closed methodB Two months later there is fairly good scar with a smallarea of hyperlophia at the left axilla which was treated byMEBO scar lotion The linear traumatic tattoo scar in theleft axilla was due to the initial conventional treatment

A

B

most physiological environment for woundhealing MEBT is performed by the applicationof a thin layer of topical Moist Exposed BurnOintment (MEBO) (Julphar Gulf Pharmaceuti-cal Industrial Co Ras Al-Khaima United ArabEmirates) which is an ointment consisting of anoily base of sesame oil and beeswax with herbalcomponents comprised of 18 amino acids 4fatty acids 7 polysaccharides vitamins andtrace elements and an active substance consist-ing of 025 b-sitosterol The mixture enhancesre-epithelialization and repair by providing re-quired nutrients and low partial pressure ofoxygen as well as removing necrotic tissuesthrough its unique drainage mechanismWound healing is stimulated and facilitated by

FIG 2 Mechanism of action of MEBO MEBO has aunique mechanism of wound debridement by which thenecrotic tissues get fragmented and liquefied chemicallyby esterification and saponification processes then sur-rounded by oil globules and removed physically throughthe oil frame base of the ointment The moving up glob-ules created negative suction of air providing the neces-sary oxygen

a relatively low partial pressure of oxygen andoptimal growth of fibroblasts in tissue cultureoccurs at low partial pressures of oxygen (5ndash10mmHg)(15) Dead or inflamed tissue containsfibrin that must be removed before healing canoccur These ldquofibrin cuffsrdquo may contribute to re-duced diffusion of oxygen and exchange of nu-trients and metabolic waste through affectedvessels they may prevent growth factor andother stimulatory substances for tissue repairfrom reaching the cells(16ndash17)

MATERIALS AND METHODS

Pilot Study

A pilot study was performed by retrospec-tively evaluating the records of 459 patientswho were treated with MEBO between May

1996 and September 1998 and then clinicallyevaluating these patients 245 of these patientswere from the Burn and Plastic Surgery Unitof Rashid Hospital and 214 patients were fromthe Gulf Plastic Surgery Center Dubai UnitedArab Emirates The clinical results were de-fined as the following

1 Excellent result Minimal or no scar with fullfunction and patient satisfaction

2 Good result Scar is acceptable functionallyandor aesthetically

3 No effect Treatment was either discontin-ued interrupted shifted to another treat-ment modality or produced slow or noprogress

Moist exposed wound treatment with MEBOin 214 private patients in the pilot study showed

MEBO IN WOUNDS MANAGEMENT 29

A B C

FIG 4 Direct flame burn of the face and neck treated with MEBO only A Day 1 B Day 9 Almost complete heal-ing of all burns except some parts of the deep areas of the neck and ear C Day 33 Complete healing with good colorof skin

A B

FIG 5 A Child with superficial and deep burns affecting his chest neck and ear treated (B) with MEBO

excellent results in 83 (Table 1) and in 63 ofpatients treated in the hospital (Table 2)

The MEBO treatment healing time wasshorter than with the other modalities Healingranged from 1 to 16 weeks (mean 31 weeks)

Retrospective Study

A retrospective critical analysis of 27 patientsselected from the pilot study was carried outSelection criteria included the following

1 Half of the patients were treated with MEBOexclusively

2 Half of the patients were treated with dif-ferent types of dressings (antibiotic impreg-nated gauze hydrocolloidal or betadinewith saline) before being switched to MEBO

3 During the course of treatment with MEBOno other medication or dressing modalitywas used

4 Standard application of MEBO was re-quired

5 All patients continued MEBO treatment un-til the wound(s) healed completely

6 All patients had daily observation during hos-pitalization and weekly follow-up thereafter

7 Periodic photographs of the wound healingwere taken

There were 2 females and 25 males with agesranging from under 20 to over 61 years with408 in the 21- to 30-year-old age group (Table3) Males tend to be more exposed to injury be-cause of profession or lifestyle The etiology ofthe wounds included partial thickness burn(16) full-thickness burn (3) diabetic foot ul-cer(s) (6) and pressure sore (2) Six patients re-quired systemic antibiotics during the courseof treatment Patients treated with MEBO didnot require debridement while six patients(46) who had dry or hydrocolloidal dressingrequired sharp debridement

Cultures were taken every other day fromopen wounds and during dressing changes onwounds with occlusive treatment Various or-ganisms were encountered (Table 4)

Prospective Study

Twenty patients were selected randomly fora prospective clinical trial carried out betweenNovember 1998 and March 1999 Ten patientswere from the hospital (6 male and 4 female)

AL-NUMAIRY30

TABLE 1 RESULTS OF MEBO TREATMENT OF 214 PRIVATE CLINIC PATIENTS

NumberResults (Number of Patients)

Condition of Patients Excellent Good No Effect

Chemical peel 64 61 3 mdashEpilaser 53 47 5 1General plastic 47 29 14 4Aesthetic laser 41 32 6 3Burn 7 6 1 mdashSevere sunburn 2 2 mdash mdash

Total 214 177 29 8

TABLE 2 RESULTS OF MEBO TREATMENT IN 245 HOSPITAL PATIENTS

NumberResults (Number of Patients)

Condition of Patients Excellent Good No Effect

Burns 118 83 31 4Other injuries 47 24 21 2Pressure sores 35 17 14 4Children burns 25 22 2 1Diabetic ulcer 18 11 4 3Severe sunburn 2 2 mdash mdashTotal 245 159 72 14

in one patient and good results in two patientsThere was no effect in the one patient withpressure sore probably because of irregulartreatment

DISCUSSION

The MEBO was used in plastic surgery forpatients with burns sunburn pressure sore di-abetic ulcers skin graft donor site and all typesof surgical and traumatic wounds whereas inaesthetic surgery the indications were forsurgery laser treatment and chemical peel

CONCLUSIONS

The study showed that use of MEBO showedconsistently good results and is a simple safeeasily available and cost-effective method ofmanagement for open wounds

The results of this study are presented withrespect to the functional and aesthetic im-provement of the wound and status of this typeof dressing in wound healing

MEBO IN WOUNDS MANAGEMENT 31

TABLE 3 AGE DISTRIBUTION OF

RETROSPECTIVE STUDY PATIENTS

Age Number of Patients

20 321ndash30 1131ndash40 241ndash50 451ndash60 560 2

A B

FIG 6 A A deep dermal burn of the trunk in ayoung man was treated conservatively with MEBO (B)

and 10 patients were from the private clinic (1male 6 female and 4 children) The wound eti-ology included eight burns four diabetic ul-cers four laser treatments one pressure soreand three chemical peels Eight patients weretreated solely with MEBO Twelve patients re-quired systemic antibiotics during the courseof treatment

The duration of healing ranged from 1 to 12weeks Patients with diabetic ulcers (four) hadexcellent results in 1 patient and good resultsin three patients Burn patients (eight) showedexcellent results in three patients and good re-sults in five patients Postlaser patients (four)showed good results in all cases and postchem-ical peel patients (three) had excellent results

AL-NUMAIRY32

FIG 7 A B A traumatic subtotal scalp avulsion by a bear attack withloss of the scalp tissue deep to the skull where there is a large area de-nuted of pericranium The patient was treated with MEBO C The galiawas then covered by skin graft and the skull which was denuted of per-icranium was treated by MEBO only and healed completely Completehealing of the bare bone of the skull due to healing properties of MEBONote that the skin graft was not affected by the desloughing properties ofMEBO which affect the nonhealthy tissues

A

B C

TABLE 4 ORGANISMS ISOLATED ON WOUND CULTURES

Number Number Positive CultureType of Dressing of Patients of Patients Organism

Impregnated gauze 5 3 MRSA2 Pseudomonas aeruginosa1 Streptococcus pyogenes

Hydrocolloidal 3 1 MRSABetadine 1 saline 5 3 MRSA

1 Pseudomonas aeruginosaMEBO 14 1 MRSA

1 Candida

MRSA methicillin-resistant Staphylococcus aureus

The present article also gives an insight onthe recent and future areas of wound researchthat may provide better wound treatmentmodality applicable not only within the scopeof plastic reconstructive or aesthetic surgerybut also to all areas of surgery and medicineincluding emergency services

ACKNOWLEDGMENTS

I would like to express my deep thanks andgratitude to Drs Krzysztof Wasilewski andSaleh Saad Kadhim Plastic Surgeons RashidHospital Dubai for their contribution in thehospital part of this study

REFERENCES

1 In Maurois A The Life of Sir Alexander Fleming[translated from French by General Hopkins] NewYork NY Dutton 1959

2 Trunkey DD Trauma Sci Am 198324928ndash353 Fibroblast growth factor time to take note [editorial]

Lancet 1990336777ndash7784 Bento RF and Miniti A A comparison between fib-

rin tissue adhesive epineural suture and naturalunion in infratemporal facial nerve of cats Acta Oto-laryngol 1989465(suppl)(Sweden)1ndash35

5 Bickel SM and Ben-Layish E Use of tissue adhe-sive in the repair of lacerations in children J PediatrSurg 198823312ndash313

6 Ellis DA and Shaikh A The ideal tissue adhesivein facial plastic and reconstructive surgery J Oto-laryngol 19901968ndash72

7 Gospodarowicz D Fibroblast growth factor Chem-ical structure and biologic function Clin Orthop 1990257221ndash248

8 McGrath MH Peptide growth factors and woundhealing Clin Plast Surg 199017421ndash432

9 Mustoe TA Landes A Cromtack DT et al Dif-

ferential acceleration of healing of surgical incisionsin the rabbit gastrointestinal tract by platelet-derivedgrowth factor and transforming growth factor typebeta Surgery 1990108324ndash330

10 Pierce GF Mustoe TA Lingelbach J et al Trans-forming growth factor B reverses glucocorticoid-in-duced wound healing deficit in rats Possible regula-tion in macrophages by platelet-derived growthfactor Proc Natl Acad Sci U S A 1998862229ndash2233

11 Ross R Bowen-Pope DF and Raines EWPlatelet-derived growth factor and its role in healthand disease Philos Trans R Soc Lond B Biol Sci1990327155ndash169

12 Ross R Platelet-derived growth factor Lancet 198911179ndash1182

13 Winter GD Formation of the scab and the rate ep-ithelialization of superficial wounds in the skin ofyoung domestic pig Nature 1962193293ndash294

14 Eaglestein WH Occlusive dressing J Dermatol SurgOncol 199319716ndash720

15 Varghese MC Balin AK Carter M and GaldwellD Local environment of chronic wounds under syn-thetic dressing Arch Dermatol 198612252ndash57

16 Burnard KG Whimster IW Naidoo A et al Per-icapillary fibrin deposition in ulcer bearing skin of thelower limb The cause of lipodermosclerosis and ve-nous ulceration Br Med J 19822851071ndash1072

17 Falanga V and Eaglestein WH The ldquotraprdquo hy-pothesis of venous ulceration Lancet 19933411006ndash1007

Address reprint requests toAli Al-Numairy MD

DirectorGulf Plastic Surgery Center

PO Box 145Dubai United Arab Emirates

E-mail numairyemiratesnetae

Accepted for publication September 12 1999

MEBO IN WOUNDS MANAGEMENT 33

FIG 1 Wound healing is the result of three factors thepatient the wound and cells involved Each affects andis affected by the other

AL-NUMAIRY28

FIG 3 A Scald burn of the anterior chest upper abdom-inal wall and left axilla 3 weeks previously When the childwas an inpatient the family was advised to proceed withskin grafting but refused He was treated with a conven-tional dressing as an outpatient The patient was seen in myprivate practice where after 3 weeks the burn still had adeep slough The wounds looked to be deep partial thick-ness with areas of full thickness burn The patient wastreated conservatively by MEBO (12 hourly) closed methodB Two months later there is fairly good scar with a smallarea of hyperlophia at the left axilla which was treated byMEBO scar lotion The linear traumatic tattoo scar in theleft axilla was due to the initial conventional treatment

A

B

most physiological environment for woundhealing MEBT is performed by the applicationof a thin layer of topical Moist Exposed BurnOintment (MEBO) (Julphar Gulf Pharmaceuti-cal Industrial Co Ras Al-Khaima United ArabEmirates) which is an ointment consisting of anoily base of sesame oil and beeswax with herbalcomponents comprised of 18 amino acids 4fatty acids 7 polysaccharides vitamins andtrace elements and an active substance consist-ing of 025 b-sitosterol The mixture enhancesre-epithelialization and repair by providing re-quired nutrients and low partial pressure ofoxygen as well as removing necrotic tissuesthrough its unique drainage mechanismWound healing is stimulated and facilitated by

FIG 2 Mechanism of action of MEBO MEBO has aunique mechanism of wound debridement by which thenecrotic tissues get fragmented and liquefied chemicallyby esterification and saponification processes then sur-rounded by oil globules and removed physically throughthe oil frame base of the ointment The moving up glob-ules created negative suction of air providing the neces-sary oxygen

a relatively low partial pressure of oxygen andoptimal growth of fibroblasts in tissue cultureoccurs at low partial pressures of oxygen (5ndash10mmHg)(15) Dead or inflamed tissue containsfibrin that must be removed before healing canoccur These ldquofibrin cuffsrdquo may contribute to re-duced diffusion of oxygen and exchange of nu-trients and metabolic waste through affectedvessels they may prevent growth factor andother stimulatory substances for tissue repairfrom reaching the cells(16ndash17)

MATERIALS AND METHODS

Pilot Study

A pilot study was performed by retrospec-tively evaluating the records of 459 patientswho were treated with MEBO between May

1996 and September 1998 and then clinicallyevaluating these patients 245 of these patientswere from the Burn and Plastic Surgery Unitof Rashid Hospital and 214 patients were fromthe Gulf Plastic Surgery Center Dubai UnitedArab Emirates The clinical results were de-fined as the following

1 Excellent result Minimal or no scar with fullfunction and patient satisfaction

2 Good result Scar is acceptable functionallyandor aesthetically

3 No effect Treatment was either discontin-ued interrupted shifted to another treat-ment modality or produced slow or noprogress

Moist exposed wound treatment with MEBOin 214 private patients in the pilot study showed

MEBO IN WOUNDS MANAGEMENT 29

A B C

FIG 4 Direct flame burn of the face and neck treated with MEBO only A Day 1 B Day 9 Almost complete heal-ing of all burns except some parts of the deep areas of the neck and ear C Day 33 Complete healing with good colorof skin

A B

FIG 5 A Child with superficial and deep burns affecting his chest neck and ear treated (B) with MEBO

excellent results in 83 (Table 1) and in 63 ofpatients treated in the hospital (Table 2)

The MEBO treatment healing time wasshorter than with the other modalities Healingranged from 1 to 16 weeks (mean 31 weeks)

Retrospective Study

A retrospective critical analysis of 27 patientsselected from the pilot study was carried outSelection criteria included the following

1 Half of the patients were treated with MEBOexclusively

2 Half of the patients were treated with dif-ferent types of dressings (antibiotic impreg-nated gauze hydrocolloidal or betadinewith saline) before being switched to MEBO

3 During the course of treatment with MEBOno other medication or dressing modalitywas used

4 Standard application of MEBO was re-quired

5 All patients continued MEBO treatment un-til the wound(s) healed completely

6 All patients had daily observation during hos-pitalization and weekly follow-up thereafter

7 Periodic photographs of the wound healingwere taken

There were 2 females and 25 males with agesranging from under 20 to over 61 years with408 in the 21- to 30-year-old age group (Table3) Males tend to be more exposed to injury be-cause of profession or lifestyle The etiology ofthe wounds included partial thickness burn(16) full-thickness burn (3) diabetic foot ul-cer(s) (6) and pressure sore (2) Six patients re-quired systemic antibiotics during the courseof treatment Patients treated with MEBO didnot require debridement while six patients(46) who had dry or hydrocolloidal dressingrequired sharp debridement

Cultures were taken every other day fromopen wounds and during dressing changes onwounds with occlusive treatment Various or-ganisms were encountered (Table 4)

Prospective Study

Twenty patients were selected randomly fora prospective clinical trial carried out betweenNovember 1998 and March 1999 Ten patientswere from the hospital (6 male and 4 female)

AL-NUMAIRY30

TABLE 1 RESULTS OF MEBO TREATMENT OF 214 PRIVATE CLINIC PATIENTS

NumberResults (Number of Patients)

Condition of Patients Excellent Good No Effect

Chemical peel 64 61 3 mdashEpilaser 53 47 5 1General plastic 47 29 14 4Aesthetic laser 41 32 6 3Burn 7 6 1 mdashSevere sunburn 2 2 mdash mdash

Total 214 177 29 8

TABLE 2 RESULTS OF MEBO TREATMENT IN 245 HOSPITAL PATIENTS

NumberResults (Number of Patients)

Condition of Patients Excellent Good No Effect

Burns 118 83 31 4Other injuries 47 24 21 2Pressure sores 35 17 14 4Children burns 25 22 2 1Diabetic ulcer 18 11 4 3Severe sunburn 2 2 mdash mdashTotal 245 159 72 14

in one patient and good results in two patientsThere was no effect in the one patient withpressure sore probably because of irregulartreatment

DISCUSSION

The MEBO was used in plastic surgery forpatients with burns sunburn pressure sore di-abetic ulcers skin graft donor site and all typesof surgical and traumatic wounds whereas inaesthetic surgery the indications were forsurgery laser treatment and chemical peel

CONCLUSIONS

The study showed that use of MEBO showedconsistently good results and is a simple safeeasily available and cost-effective method ofmanagement for open wounds

The results of this study are presented withrespect to the functional and aesthetic im-provement of the wound and status of this typeof dressing in wound healing

MEBO IN WOUNDS MANAGEMENT 31

TABLE 3 AGE DISTRIBUTION OF

RETROSPECTIVE STUDY PATIENTS

Age Number of Patients

20 321ndash30 1131ndash40 241ndash50 451ndash60 560 2

A B

FIG 6 A A deep dermal burn of the trunk in ayoung man was treated conservatively with MEBO (B)

and 10 patients were from the private clinic (1male 6 female and 4 children) The wound eti-ology included eight burns four diabetic ul-cers four laser treatments one pressure soreand three chemical peels Eight patients weretreated solely with MEBO Twelve patients re-quired systemic antibiotics during the courseof treatment

The duration of healing ranged from 1 to 12weeks Patients with diabetic ulcers (four) hadexcellent results in 1 patient and good resultsin three patients Burn patients (eight) showedexcellent results in three patients and good re-sults in five patients Postlaser patients (four)showed good results in all cases and postchem-ical peel patients (three) had excellent results

AL-NUMAIRY32

FIG 7 A B A traumatic subtotal scalp avulsion by a bear attack withloss of the scalp tissue deep to the skull where there is a large area de-nuted of pericranium The patient was treated with MEBO C The galiawas then covered by skin graft and the skull which was denuted of per-icranium was treated by MEBO only and healed completely Completehealing of the bare bone of the skull due to healing properties of MEBONote that the skin graft was not affected by the desloughing properties ofMEBO which affect the nonhealthy tissues

A

B C

TABLE 4 ORGANISMS ISOLATED ON WOUND CULTURES

Number Number Positive CultureType of Dressing of Patients of Patients Organism

Impregnated gauze 5 3 MRSA2 Pseudomonas aeruginosa1 Streptococcus pyogenes

Hydrocolloidal 3 1 MRSABetadine 1 saline 5 3 MRSA

1 Pseudomonas aeruginosaMEBO 14 1 MRSA

1 Candida

MRSA methicillin-resistant Staphylococcus aureus

The present article also gives an insight onthe recent and future areas of wound researchthat may provide better wound treatmentmodality applicable not only within the scopeof plastic reconstructive or aesthetic surgerybut also to all areas of surgery and medicineincluding emergency services

ACKNOWLEDGMENTS

I would like to express my deep thanks andgratitude to Drs Krzysztof Wasilewski andSaleh Saad Kadhim Plastic Surgeons RashidHospital Dubai for their contribution in thehospital part of this study

REFERENCES

1 In Maurois A The Life of Sir Alexander Fleming[translated from French by General Hopkins] NewYork NY Dutton 1959

2 Trunkey DD Trauma Sci Am 198324928ndash353 Fibroblast growth factor time to take note [editorial]

Lancet 1990336777ndash7784 Bento RF and Miniti A A comparison between fib-

rin tissue adhesive epineural suture and naturalunion in infratemporal facial nerve of cats Acta Oto-laryngol 1989465(suppl)(Sweden)1ndash35

5 Bickel SM and Ben-Layish E Use of tissue adhe-sive in the repair of lacerations in children J PediatrSurg 198823312ndash313

6 Ellis DA and Shaikh A The ideal tissue adhesivein facial plastic and reconstructive surgery J Oto-laryngol 19901968ndash72

7 Gospodarowicz D Fibroblast growth factor Chem-ical structure and biologic function Clin Orthop 1990257221ndash248

8 McGrath MH Peptide growth factors and woundhealing Clin Plast Surg 199017421ndash432

9 Mustoe TA Landes A Cromtack DT et al Dif-

ferential acceleration of healing of surgical incisionsin the rabbit gastrointestinal tract by platelet-derivedgrowth factor and transforming growth factor typebeta Surgery 1990108324ndash330

10 Pierce GF Mustoe TA Lingelbach J et al Trans-forming growth factor B reverses glucocorticoid-in-duced wound healing deficit in rats Possible regula-tion in macrophages by platelet-derived growthfactor Proc Natl Acad Sci U S A 1998862229ndash2233

11 Ross R Bowen-Pope DF and Raines EWPlatelet-derived growth factor and its role in healthand disease Philos Trans R Soc Lond B Biol Sci1990327155ndash169

12 Ross R Platelet-derived growth factor Lancet 198911179ndash1182

13 Winter GD Formation of the scab and the rate ep-ithelialization of superficial wounds in the skin ofyoung domestic pig Nature 1962193293ndash294

14 Eaglestein WH Occlusive dressing J Dermatol SurgOncol 199319716ndash720

15 Varghese MC Balin AK Carter M and GaldwellD Local environment of chronic wounds under syn-thetic dressing Arch Dermatol 198612252ndash57

16 Burnard KG Whimster IW Naidoo A et al Per-icapillary fibrin deposition in ulcer bearing skin of thelower limb The cause of lipodermosclerosis and ve-nous ulceration Br Med J 19822851071ndash1072

17 Falanga V and Eaglestein WH The ldquotraprdquo hy-pothesis of venous ulceration Lancet 19933411006ndash1007

Address reprint requests toAli Al-Numairy MD

DirectorGulf Plastic Surgery Center

PO Box 145Dubai United Arab Emirates

E-mail numairyemiratesnetae

Accepted for publication September 12 1999

MEBO IN WOUNDS MANAGEMENT 33

a relatively low partial pressure of oxygen andoptimal growth of fibroblasts in tissue cultureoccurs at low partial pressures of oxygen (5ndash10mmHg)(15) Dead or inflamed tissue containsfibrin that must be removed before healing canoccur These ldquofibrin cuffsrdquo may contribute to re-duced diffusion of oxygen and exchange of nu-trients and metabolic waste through affectedvessels they may prevent growth factor andother stimulatory substances for tissue repairfrom reaching the cells(16ndash17)

MATERIALS AND METHODS

Pilot Study

A pilot study was performed by retrospec-tively evaluating the records of 459 patientswho were treated with MEBO between May

1996 and September 1998 and then clinicallyevaluating these patients 245 of these patientswere from the Burn and Plastic Surgery Unitof Rashid Hospital and 214 patients were fromthe Gulf Plastic Surgery Center Dubai UnitedArab Emirates The clinical results were de-fined as the following

1 Excellent result Minimal or no scar with fullfunction and patient satisfaction

2 Good result Scar is acceptable functionallyandor aesthetically

3 No effect Treatment was either discontin-ued interrupted shifted to another treat-ment modality or produced slow or noprogress

Moist exposed wound treatment with MEBOin 214 private patients in the pilot study showed

MEBO IN WOUNDS MANAGEMENT 29

A B C

FIG 4 Direct flame burn of the face and neck treated with MEBO only A Day 1 B Day 9 Almost complete heal-ing of all burns except some parts of the deep areas of the neck and ear C Day 33 Complete healing with good colorof skin

A B

FIG 5 A Child with superficial and deep burns affecting his chest neck and ear treated (B) with MEBO

excellent results in 83 (Table 1) and in 63 ofpatients treated in the hospital (Table 2)

The MEBO treatment healing time wasshorter than with the other modalities Healingranged from 1 to 16 weeks (mean 31 weeks)

Retrospective Study

A retrospective critical analysis of 27 patientsselected from the pilot study was carried outSelection criteria included the following

1 Half of the patients were treated with MEBOexclusively

2 Half of the patients were treated with dif-ferent types of dressings (antibiotic impreg-nated gauze hydrocolloidal or betadinewith saline) before being switched to MEBO

3 During the course of treatment with MEBOno other medication or dressing modalitywas used

4 Standard application of MEBO was re-quired

5 All patients continued MEBO treatment un-til the wound(s) healed completely

6 All patients had daily observation during hos-pitalization and weekly follow-up thereafter

7 Periodic photographs of the wound healingwere taken

There were 2 females and 25 males with agesranging from under 20 to over 61 years with408 in the 21- to 30-year-old age group (Table3) Males tend to be more exposed to injury be-cause of profession or lifestyle The etiology ofthe wounds included partial thickness burn(16) full-thickness burn (3) diabetic foot ul-cer(s) (6) and pressure sore (2) Six patients re-quired systemic antibiotics during the courseof treatment Patients treated with MEBO didnot require debridement while six patients(46) who had dry or hydrocolloidal dressingrequired sharp debridement

Cultures were taken every other day fromopen wounds and during dressing changes onwounds with occlusive treatment Various or-ganisms were encountered (Table 4)

Prospective Study

Twenty patients were selected randomly fora prospective clinical trial carried out betweenNovember 1998 and March 1999 Ten patientswere from the hospital (6 male and 4 female)

AL-NUMAIRY30

TABLE 1 RESULTS OF MEBO TREATMENT OF 214 PRIVATE CLINIC PATIENTS

NumberResults (Number of Patients)

Condition of Patients Excellent Good No Effect

Chemical peel 64 61 3 mdashEpilaser 53 47 5 1General plastic 47 29 14 4Aesthetic laser 41 32 6 3Burn 7 6 1 mdashSevere sunburn 2 2 mdash mdash

Total 214 177 29 8

TABLE 2 RESULTS OF MEBO TREATMENT IN 245 HOSPITAL PATIENTS

NumberResults (Number of Patients)

Condition of Patients Excellent Good No Effect

Burns 118 83 31 4Other injuries 47 24 21 2Pressure sores 35 17 14 4Children burns 25 22 2 1Diabetic ulcer 18 11 4 3Severe sunburn 2 2 mdash mdashTotal 245 159 72 14

in one patient and good results in two patientsThere was no effect in the one patient withpressure sore probably because of irregulartreatment

DISCUSSION

The MEBO was used in plastic surgery forpatients with burns sunburn pressure sore di-abetic ulcers skin graft donor site and all typesof surgical and traumatic wounds whereas inaesthetic surgery the indications were forsurgery laser treatment and chemical peel

CONCLUSIONS

The study showed that use of MEBO showedconsistently good results and is a simple safeeasily available and cost-effective method ofmanagement for open wounds

The results of this study are presented withrespect to the functional and aesthetic im-provement of the wound and status of this typeof dressing in wound healing

MEBO IN WOUNDS MANAGEMENT 31

TABLE 3 AGE DISTRIBUTION OF

RETROSPECTIVE STUDY PATIENTS

Age Number of Patients

20 321ndash30 1131ndash40 241ndash50 451ndash60 560 2

A B

FIG 6 A A deep dermal burn of the trunk in ayoung man was treated conservatively with MEBO (B)

and 10 patients were from the private clinic (1male 6 female and 4 children) The wound eti-ology included eight burns four diabetic ul-cers four laser treatments one pressure soreand three chemical peels Eight patients weretreated solely with MEBO Twelve patients re-quired systemic antibiotics during the courseof treatment

The duration of healing ranged from 1 to 12weeks Patients with diabetic ulcers (four) hadexcellent results in 1 patient and good resultsin three patients Burn patients (eight) showedexcellent results in three patients and good re-sults in five patients Postlaser patients (four)showed good results in all cases and postchem-ical peel patients (three) had excellent results

AL-NUMAIRY32

FIG 7 A B A traumatic subtotal scalp avulsion by a bear attack withloss of the scalp tissue deep to the skull where there is a large area de-nuted of pericranium The patient was treated with MEBO C The galiawas then covered by skin graft and the skull which was denuted of per-icranium was treated by MEBO only and healed completely Completehealing of the bare bone of the skull due to healing properties of MEBONote that the skin graft was not affected by the desloughing properties ofMEBO which affect the nonhealthy tissues

A

B C

TABLE 4 ORGANISMS ISOLATED ON WOUND CULTURES

Number Number Positive CultureType of Dressing of Patients of Patients Organism

Impregnated gauze 5 3 MRSA2 Pseudomonas aeruginosa1 Streptococcus pyogenes

Hydrocolloidal 3 1 MRSABetadine 1 saline 5 3 MRSA

1 Pseudomonas aeruginosaMEBO 14 1 MRSA

1 Candida

MRSA methicillin-resistant Staphylococcus aureus

The present article also gives an insight onthe recent and future areas of wound researchthat may provide better wound treatmentmodality applicable not only within the scopeof plastic reconstructive or aesthetic surgerybut also to all areas of surgery and medicineincluding emergency services

ACKNOWLEDGMENTS

I would like to express my deep thanks andgratitude to Drs Krzysztof Wasilewski andSaleh Saad Kadhim Plastic Surgeons RashidHospital Dubai for their contribution in thehospital part of this study

REFERENCES

1 In Maurois A The Life of Sir Alexander Fleming[translated from French by General Hopkins] NewYork NY Dutton 1959

2 Trunkey DD Trauma Sci Am 198324928ndash353 Fibroblast growth factor time to take note [editorial]

Lancet 1990336777ndash7784 Bento RF and Miniti A A comparison between fib-

rin tissue adhesive epineural suture and naturalunion in infratemporal facial nerve of cats Acta Oto-laryngol 1989465(suppl)(Sweden)1ndash35

5 Bickel SM and Ben-Layish E Use of tissue adhe-sive in the repair of lacerations in children J PediatrSurg 198823312ndash313

6 Ellis DA and Shaikh A The ideal tissue adhesivein facial plastic and reconstructive surgery J Oto-laryngol 19901968ndash72

7 Gospodarowicz D Fibroblast growth factor Chem-ical structure and biologic function Clin Orthop 1990257221ndash248

8 McGrath MH Peptide growth factors and woundhealing Clin Plast Surg 199017421ndash432

9 Mustoe TA Landes A Cromtack DT et al Dif-

ferential acceleration of healing of surgical incisionsin the rabbit gastrointestinal tract by platelet-derivedgrowth factor and transforming growth factor typebeta Surgery 1990108324ndash330

10 Pierce GF Mustoe TA Lingelbach J et al Trans-forming growth factor B reverses glucocorticoid-in-duced wound healing deficit in rats Possible regula-tion in macrophages by platelet-derived growthfactor Proc Natl Acad Sci U S A 1998862229ndash2233

11 Ross R Bowen-Pope DF and Raines EWPlatelet-derived growth factor and its role in healthand disease Philos Trans R Soc Lond B Biol Sci1990327155ndash169

12 Ross R Platelet-derived growth factor Lancet 198911179ndash1182

13 Winter GD Formation of the scab and the rate ep-ithelialization of superficial wounds in the skin ofyoung domestic pig Nature 1962193293ndash294

14 Eaglestein WH Occlusive dressing J Dermatol SurgOncol 199319716ndash720

15 Varghese MC Balin AK Carter M and GaldwellD Local environment of chronic wounds under syn-thetic dressing Arch Dermatol 198612252ndash57

16 Burnard KG Whimster IW Naidoo A et al Per-icapillary fibrin deposition in ulcer bearing skin of thelower limb The cause of lipodermosclerosis and ve-nous ulceration Br Med J 19822851071ndash1072

17 Falanga V and Eaglestein WH The ldquotraprdquo hy-pothesis of venous ulceration Lancet 19933411006ndash1007

Address reprint requests toAli Al-Numairy MD

DirectorGulf Plastic Surgery Center

PO Box 145Dubai United Arab Emirates

E-mail numairyemiratesnetae

Accepted for publication September 12 1999

MEBO IN WOUNDS MANAGEMENT 33

excellent results in 83 (Table 1) and in 63 ofpatients treated in the hospital (Table 2)

The MEBO treatment healing time wasshorter than with the other modalities Healingranged from 1 to 16 weeks (mean 31 weeks)

Retrospective Study

A retrospective critical analysis of 27 patientsselected from the pilot study was carried outSelection criteria included the following

1 Half of the patients were treated with MEBOexclusively

2 Half of the patients were treated with dif-ferent types of dressings (antibiotic impreg-nated gauze hydrocolloidal or betadinewith saline) before being switched to MEBO

3 During the course of treatment with MEBOno other medication or dressing modalitywas used

4 Standard application of MEBO was re-quired

5 All patients continued MEBO treatment un-til the wound(s) healed completely

6 All patients had daily observation during hos-pitalization and weekly follow-up thereafter

7 Periodic photographs of the wound healingwere taken

There were 2 females and 25 males with agesranging from under 20 to over 61 years with408 in the 21- to 30-year-old age group (Table3) Males tend to be more exposed to injury be-cause of profession or lifestyle The etiology ofthe wounds included partial thickness burn(16) full-thickness burn (3) diabetic foot ul-cer(s) (6) and pressure sore (2) Six patients re-quired systemic antibiotics during the courseof treatment Patients treated with MEBO didnot require debridement while six patients(46) who had dry or hydrocolloidal dressingrequired sharp debridement

Cultures were taken every other day fromopen wounds and during dressing changes onwounds with occlusive treatment Various or-ganisms were encountered (Table 4)

Prospective Study

Twenty patients were selected randomly fora prospective clinical trial carried out betweenNovember 1998 and March 1999 Ten patientswere from the hospital (6 male and 4 female)

AL-NUMAIRY30

TABLE 1 RESULTS OF MEBO TREATMENT OF 214 PRIVATE CLINIC PATIENTS

NumberResults (Number of Patients)

Condition of Patients Excellent Good No Effect

Chemical peel 64 61 3 mdashEpilaser 53 47 5 1General plastic 47 29 14 4Aesthetic laser 41 32 6 3Burn 7 6 1 mdashSevere sunburn 2 2 mdash mdash

Total 214 177 29 8

TABLE 2 RESULTS OF MEBO TREATMENT IN 245 HOSPITAL PATIENTS

NumberResults (Number of Patients)

Condition of Patients Excellent Good No Effect

Burns 118 83 31 4Other injuries 47 24 21 2Pressure sores 35 17 14 4Children burns 25 22 2 1Diabetic ulcer 18 11 4 3Severe sunburn 2 2 mdash mdashTotal 245 159 72 14

in one patient and good results in two patientsThere was no effect in the one patient withpressure sore probably because of irregulartreatment

DISCUSSION

The MEBO was used in plastic surgery forpatients with burns sunburn pressure sore di-abetic ulcers skin graft donor site and all typesof surgical and traumatic wounds whereas inaesthetic surgery the indications were forsurgery laser treatment and chemical peel

CONCLUSIONS

The study showed that use of MEBO showedconsistently good results and is a simple safeeasily available and cost-effective method ofmanagement for open wounds

The results of this study are presented withrespect to the functional and aesthetic im-provement of the wound and status of this typeof dressing in wound healing

MEBO IN WOUNDS MANAGEMENT 31

TABLE 3 AGE DISTRIBUTION OF

RETROSPECTIVE STUDY PATIENTS

Age Number of Patients

20 321ndash30 1131ndash40 241ndash50 451ndash60 560 2

A B

FIG 6 A A deep dermal burn of the trunk in ayoung man was treated conservatively with MEBO (B)

and 10 patients were from the private clinic (1male 6 female and 4 children) The wound eti-ology included eight burns four diabetic ul-cers four laser treatments one pressure soreand three chemical peels Eight patients weretreated solely with MEBO Twelve patients re-quired systemic antibiotics during the courseof treatment

The duration of healing ranged from 1 to 12weeks Patients with diabetic ulcers (four) hadexcellent results in 1 patient and good resultsin three patients Burn patients (eight) showedexcellent results in three patients and good re-sults in five patients Postlaser patients (four)showed good results in all cases and postchem-ical peel patients (three) had excellent results

AL-NUMAIRY32

FIG 7 A B A traumatic subtotal scalp avulsion by a bear attack withloss of the scalp tissue deep to the skull where there is a large area de-nuted of pericranium The patient was treated with MEBO C The galiawas then covered by skin graft and the skull which was denuted of per-icranium was treated by MEBO only and healed completely Completehealing of the bare bone of the skull due to healing properties of MEBONote that the skin graft was not affected by the desloughing properties ofMEBO which affect the nonhealthy tissues

A

B C

TABLE 4 ORGANISMS ISOLATED ON WOUND CULTURES

Number Number Positive CultureType of Dressing of Patients of Patients Organism

Impregnated gauze 5 3 MRSA2 Pseudomonas aeruginosa1 Streptococcus pyogenes

Hydrocolloidal 3 1 MRSABetadine 1 saline 5 3 MRSA

1 Pseudomonas aeruginosaMEBO 14 1 MRSA

1 Candida

MRSA methicillin-resistant Staphylococcus aureus

The present article also gives an insight onthe recent and future areas of wound researchthat may provide better wound treatmentmodality applicable not only within the scopeof plastic reconstructive or aesthetic surgerybut also to all areas of surgery and medicineincluding emergency services

ACKNOWLEDGMENTS

I would like to express my deep thanks andgratitude to Drs Krzysztof Wasilewski andSaleh Saad Kadhim Plastic Surgeons RashidHospital Dubai for their contribution in thehospital part of this study

REFERENCES

1 In Maurois A The Life of Sir Alexander Fleming[translated from French by General Hopkins] NewYork NY Dutton 1959

2 Trunkey DD Trauma Sci Am 198324928ndash353 Fibroblast growth factor time to take note [editorial]

Lancet 1990336777ndash7784 Bento RF and Miniti A A comparison between fib-

rin tissue adhesive epineural suture and naturalunion in infratemporal facial nerve of cats Acta Oto-laryngol 1989465(suppl)(Sweden)1ndash35

5 Bickel SM and Ben-Layish E Use of tissue adhe-sive in the repair of lacerations in children J PediatrSurg 198823312ndash313

6 Ellis DA and Shaikh A The ideal tissue adhesivein facial plastic and reconstructive surgery J Oto-laryngol 19901968ndash72

7 Gospodarowicz D Fibroblast growth factor Chem-ical structure and biologic function Clin Orthop 1990257221ndash248

8 McGrath MH Peptide growth factors and woundhealing Clin Plast Surg 199017421ndash432

9 Mustoe TA Landes A Cromtack DT et al Dif-

ferential acceleration of healing of surgical incisionsin the rabbit gastrointestinal tract by platelet-derivedgrowth factor and transforming growth factor typebeta Surgery 1990108324ndash330

10 Pierce GF Mustoe TA Lingelbach J et al Trans-forming growth factor B reverses glucocorticoid-in-duced wound healing deficit in rats Possible regula-tion in macrophages by platelet-derived growthfactor Proc Natl Acad Sci U S A 1998862229ndash2233

11 Ross R Bowen-Pope DF and Raines EWPlatelet-derived growth factor and its role in healthand disease Philos Trans R Soc Lond B Biol Sci1990327155ndash169

12 Ross R Platelet-derived growth factor Lancet 198911179ndash1182

13 Winter GD Formation of the scab and the rate ep-ithelialization of superficial wounds in the skin ofyoung domestic pig Nature 1962193293ndash294

14 Eaglestein WH Occlusive dressing J Dermatol SurgOncol 199319716ndash720

15 Varghese MC Balin AK Carter M and GaldwellD Local environment of chronic wounds under syn-thetic dressing Arch Dermatol 198612252ndash57

16 Burnard KG Whimster IW Naidoo A et al Per-icapillary fibrin deposition in ulcer bearing skin of thelower limb The cause of lipodermosclerosis and ve-nous ulceration Br Med J 19822851071ndash1072

17 Falanga V and Eaglestein WH The ldquotraprdquo hy-pothesis of venous ulceration Lancet 19933411006ndash1007

Address reprint requests toAli Al-Numairy MD

DirectorGulf Plastic Surgery Center

PO Box 145Dubai United Arab Emirates

E-mail numairyemiratesnetae

Accepted for publication September 12 1999

MEBO IN WOUNDS MANAGEMENT 33

in one patient and good results in two patientsThere was no effect in the one patient withpressure sore probably because of irregulartreatment

DISCUSSION

The MEBO was used in plastic surgery forpatients with burns sunburn pressure sore di-abetic ulcers skin graft donor site and all typesof surgical and traumatic wounds whereas inaesthetic surgery the indications were forsurgery laser treatment and chemical peel

CONCLUSIONS

The study showed that use of MEBO showedconsistently good results and is a simple safeeasily available and cost-effective method ofmanagement for open wounds

The results of this study are presented withrespect to the functional and aesthetic im-provement of the wound and status of this typeof dressing in wound healing

MEBO IN WOUNDS MANAGEMENT 31

TABLE 3 AGE DISTRIBUTION OF

RETROSPECTIVE STUDY PATIENTS

Age Number of Patients

20 321ndash30 1131ndash40 241ndash50 451ndash60 560 2

A B

FIG 6 A A deep dermal burn of the trunk in ayoung man was treated conservatively with MEBO (B)

and 10 patients were from the private clinic (1male 6 female and 4 children) The wound eti-ology included eight burns four diabetic ul-cers four laser treatments one pressure soreand three chemical peels Eight patients weretreated solely with MEBO Twelve patients re-quired systemic antibiotics during the courseof treatment

The duration of healing ranged from 1 to 12weeks Patients with diabetic ulcers (four) hadexcellent results in 1 patient and good resultsin three patients Burn patients (eight) showedexcellent results in three patients and good re-sults in five patients Postlaser patients (four)showed good results in all cases and postchem-ical peel patients (three) had excellent results

AL-NUMAIRY32

FIG 7 A B A traumatic subtotal scalp avulsion by a bear attack withloss of the scalp tissue deep to the skull where there is a large area de-nuted of pericranium The patient was treated with MEBO C The galiawas then covered by skin graft and the skull which was denuted of per-icranium was treated by MEBO only and healed completely Completehealing of the bare bone of the skull due to healing properties of MEBONote that the skin graft was not affected by the desloughing properties ofMEBO which affect the nonhealthy tissues

A

B C

TABLE 4 ORGANISMS ISOLATED ON WOUND CULTURES

Number Number Positive CultureType of Dressing of Patients of Patients Organism

Impregnated gauze 5 3 MRSA2 Pseudomonas aeruginosa1 Streptococcus pyogenes

Hydrocolloidal 3 1 MRSABetadine 1 saline 5 3 MRSA

1 Pseudomonas aeruginosaMEBO 14 1 MRSA

1 Candida

MRSA methicillin-resistant Staphylococcus aureus

The present article also gives an insight onthe recent and future areas of wound researchthat may provide better wound treatmentmodality applicable not only within the scopeof plastic reconstructive or aesthetic surgerybut also to all areas of surgery and medicineincluding emergency services

ACKNOWLEDGMENTS

I would like to express my deep thanks andgratitude to Drs Krzysztof Wasilewski andSaleh Saad Kadhim Plastic Surgeons RashidHospital Dubai for their contribution in thehospital part of this study

REFERENCES

1 In Maurois A The Life of Sir Alexander Fleming[translated from French by General Hopkins] NewYork NY Dutton 1959

2 Trunkey DD Trauma Sci Am 198324928ndash353 Fibroblast growth factor time to take note [editorial]

Lancet 1990336777ndash7784 Bento RF and Miniti A A comparison between fib-

rin tissue adhesive epineural suture and naturalunion in infratemporal facial nerve of cats Acta Oto-laryngol 1989465(suppl)(Sweden)1ndash35

5 Bickel SM and Ben-Layish E Use of tissue adhe-sive in the repair of lacerations in children J PediatrSurg 198823312ndash313

6 Ellis DA and Shaikh A The ideal tissue adhesivein facial plastic and reconstructive surgery J Oto-laryngol 19901968ndash72

7 Gospodarowicz D Fibroblast growth factor Chem-ical structure and biologic function Clin Orthop 1990257221ndash248

8 McGrath MH Peptide growth factors and woundhealing Clin Plast Surg 199017421ndash432

9 Mustoe TA Landes A Cromtack DT et al Dif-

ferential acceleration of healing of surgical incisionsin the rabbit gastrointestinal tract by platelet-derivedgrowth factor and transforming growth factor typebeta Surgery 1990108324ndash330

10 Pierce GF Mustoe TA Lingelbach J et al Trans-forming growth factor B reverses glucocorticoid-in-duced wound healing deficit in rats Possible regula-tion in macrophages by platelet-derived growthfactor Proc Natl Acad Sci U S A 1998862229ndash2233

11 Ross R Bowen-Pope DF and Raines EWPlatelet-derived growth factor and its role in healthand disease Philos Trans R Soc Lond B Biol Sci1990327155ndash169

12 Ross R Platelet-derived growth factor Lancet 198911179ndash1182

13 Winter GD Formation of the scab and the rate ep-ithelialization of superficial wounds in the skin ofyoung domestic pig Nature 1962193293ndash294

14 Eaglestein WH Occlusive dressing J Dermatol SurgOncol 199319716ndash720

15 Varghese MC Balin AK Carter M and GaldwellD Local environment of chronic wounds under syn-thetic dressing Arch Dermatol 198612252ndash57

16 Burnard KG Whimster IW Naidoo A et al Per-icapillary fibrin deposition in ulcer bearing skin of thelower limb The cause of lipodermosclerosis and ve-nous ulceration Br Med J 19822851071ndash1072

17 Falanga V and Eaglestein WH The ldquotraprdquo hy-pothesis of venous ulceration Lancet 19933411006ndash1007

Address reprint requests toAli Al-Numairy MD

DirectorGulf Plastic Surgery Center

PO Box 145Dubai United Arab Emirates

E-mail numairyemiratesnetae

Accepted for publication September 12 1999

MEBO IN WOUNDS MANAGEMENT 33

AL-NUMAIRY32

FIG 7 A B A traumatic subtotal scalp avulsion by a bear attack withloss of the scalp tissue deep to the skull where there is a large area de-nuted of pericranium The patient was treated with MEBO C The galiawas then covered by skin graft and the skull which was denuted of per-icranium was treated by MEBO only and healed completely Completehealing of the bare bone of the skull due to healing properties of MEBONote that the skin graft was not affected by the desloughing properties ofMEBO which affect the nonhealthy tissues

A

B C

TABLE 4 ORGANISMS ISOLATED ON WOUND CULTURES

Number Number Positive CultureType of Dressing of Patients of Patients Organism

Impregnated gauze 5 3 MRSA2 Pseudomonas aeruginosa1 Streptococcus pyogenes

Hydrocolloidal 3 1 MRSABetadine 1 saline 5 3 MRSA

1 Pseudomonas aeruginosaMEBO 14 1 MRSA

1 Candida

MRSA methicillin-resistant Staphylococcus aureus

The present article also gives an insight onthe recent and future areas of wound researchthat may provide better wound treatmentmodality applicable not only within the scopeof plastic reconstructive or aesthetic surgerybut also to all areas of surgery and medicineincluding emergency services

ACKNOWLEDGMENTS

I would like to express my deep thanks andgratitude to Drs Krzysztof Wasilewski andSaleh Saad Kadhim Plastic Surgeons RashidHospital Dubai for their contribution in thehospital part of this study

REFERENCES

1 In Maurois A The Life of Sir Alexander Fleming[translated from French by General Hopkins] NewYork NY Dutton 1959

2 Trunkey DD Trauma Sci Am 198324928ndash353 Fibroblast growth factor time to take note [editorial]

Lancet 1990336777ndash7784 Bento RF and Miniti A A comparison between fib-

rin tissue adhesive epineural suture and naturalunion in infratemporal facial nerve of cats Acta Oto-laryngol 1989465(suppl)(Sweden)1ndash35

5 Bickel SM and Ben-Layish E Use of tissue adhe-sive in the repair of lacerations in children J PediatrSurg 198823312ndash313

6 Ellis DA and Shaikh A The ideal tissue adhesivein facial plastic and reconstructive surgery J Oto-laryngol 19901968ndash72

7 Gospodarowicz D Fibroblast growth factor Chem-ical structure and biologic function Clin Orthop 1990257221ndash248

8 McGrath MH Peptide growth factors and woundhealing Clin Plast Surg 199017421ndash432

9 Mustoe TA Landes A Cromtack DT et al Dif-

ferential acceleration of healing of surgical incisionsin the rabbit gastrointestinal tract by platelet-derivedgrowth factor and transforming growth factor typebeta Surgery 1990108324ndash330

10 Pierce GF Mustoe TA Lingelbach J et al Trans-forming growth factor B reverses glucocorticoid-in-duced wound healing deficit in rats Possible regula-tion in macrophages by platelet-derived growthfactor Proc Natl Acad Sci U S A 1998862229ndash2233

11 Ross R Bowen-Pope DF and Raines EWPlatelet-derived growth factor and its role in healthand disease Philos Trans R Soc Lond B Biol Sci1990327155ndash169

12 Ross R Platelet-derived growth factor Lancet 198911179ndash1182

13 Winter GD Formation of the scab and the rate ep-ithelialization of superficial wounds in the skin ofyoung domestic pig Nature 1962193293ndash294

14 Eaglestein WH Occlusive dressing J Dermatol SurgOncol 199319716ndash720

15 Varghese MC Balin AK Carter M and GaldwellD Local environment of chronic wounds under syn-thetic dressing Arch Dermatol 198612252ndash57

16 Burnard KG Whimster IW Naidoo A et al Per-icapillary fibrin deposition in ulcer bearing skin of thelower limb The cause of lipodermosclerosis and ve-nous ulceration Br Med J 19822851071ndash1072

17 Falanga V and Eaglestein WH The ldquotraprdquo hy-pothesis of venous ulceration Lancet 19933411006ndash1007

Address reprint requests toAli Al-Numairy MD

DirectorGulf Plastic Surgery Center

PO Box 145Dubai United Arab Emirates

E-mail numairyemiratesnetae

Accepted for publication September 12 1999

MEBO IN WOUNDS MANAGEMENT 33

The present article also gives an insight onthe recent and future areas of wound researchthat may provide better wound treatmentmodality applicable not only within the scopeof plastic reconstructive or aesthetic surgerybut also to all areas of surgery and medicineincluding emergency services

ACKNOWLEDGMENTS

I would like to express my deep thanks andgratitude to Drs Krzysztof Wasilewski andSaleh Saad Kadhim Plastic Surgeons RashidHospital Dubai for their contribution in thehospital part of this study

REFERENCES

1 In Maurois A The Life of Sir Alexander Fleming[translated from French by General Hopkins] NewYork NY Dutton 1959

2 Trunkey DD Trauma Sci Am 198324928ndash353 Fibroblast growth factor time to take note [editorial]

Lancet 1990336777ndash7784 Bento RF and Miniti A A comparison between fib-

rin tissue adhesive epineural suture and naturalunion in infratemporal facial nerve of cats Acta Oto-laryngol 1989465(suppl)(Sweden)1ndash35

5 Bickel SM and Ben-Layish E Use of tissue adhe-sive in the repair of lacerations in children J PediatrSurg 198823312ndash313

6 Ellis DA and Shaikh A The ideal tissue adhesivein facial plastic and reconstructive surgery J Oto-laryngol 19901968ndash72

7 Gospodarowicz D Fibroblast growth factor Chem-ical structure and biologic function Clin Orthop 1990257221ndash248

8 McGrath MH Peptide growth factors and woundhealing Clin Plast Surg 199017421ndash432

9 Mustoe TA Landes A Cromtack DT et al Dif-

ferential acceleration of healing of surgical incisionsin the rabbit gastrointestinal tract by platelet-derivedgrowth factor and transforming growth factor typebeta Surgery 1990108324ndash330

10 Pierce GF Mustoe TA Lingelbach J et al Trans-forming growth factor B reverses glucocorticoid-in-duced wound healing deficit in rats Possible regula-tion in macrophages by platelet-derived growthfactor Proc Natl Acad Sci U S A 1998862229ndash2233

11 Ross R Bowen-Pope DF and Raines EWPlatelet-derived growth factor and its role in healthand disease Philos Trans R Soc Lond B Biol Sci1990327155ndash169

12 Ross R Platelet-derived growth factor Lancet 198911179ndash1182

13 Winter GD Formation of the scab and the rate ep-ithelialization of superficial wounds in the skin ofyoung domestic pig Nature 1962193293ndash294

14 Eaglestein WH Occlusive dressing J Dermatol SurgOncol 199319716ndash720

15 Varghese MC Balin AK Carter M and GaldwellD Local environment of chronic wounds under syn-thetic dressing Arch Dermatol 198612252ndash57

16 Burnard KG Whimster IW Naidoo A et al Per-icapillary fibrin deposition in ulcer bearing skin of thelower limb The cause of lipodermosclerosis and ve-nous ulceration Br Med J 19822851071ndash1072

17 Falanga V and Eaglestein WH The ldquotraprdquo hy-pothesis of venous ulceration Lancet 19933411006ndash1007

Address reprint requests toAli Al-Numairy MD

DirectorGulf Plastic Surgery Center

PO Box 145Dubai United Arab Emirates

E-mail numairyemiratesnetae

Accepted for publication September 12 1999

MEBO IN WOUNDS MANAGEMENT 33