We treated 50 hospitalized patients of either sex aged between I and 76 years, as well as 25 out-patients. The treatment lasted from 4 to 25 days. All the patients were hospitalized within 24 hr post-burn. In the out-patient group, the total body surface area (TBSA) burned was between I and 6% (second- and third-degree); in the inpatient group, TBSA ranged from 5 to 70% (also secondand third-degree) Table III presents the bacteriological results are reported of Flamazine application in 35 patients. The following aspects were considered:

• the spectrum of bacteria before and after Flamazine application, at every change of dressing

• the number of bacteria in I g of tissue, with a significant value of 101 bacteria per gram (b/g) accepted as the criterion for the development of local and systemic infection

After conventional cleansing of the wounds, we used the following two methods for the application of Flamazine.

Closed method
Flamazine was applied in a layer 2-3 mm thick directly on the burn wound by applicator or by hand in a sterile glove. It was then covered with dry sterile gauze. The burn wound was sometimes covered after a preliminary spread also with Flamazine sterile gauze. When the hands were burned, they were placed in a polythene bag or sterile latex gloves containing Flamazine. In this way the movements of the hands are painless and their observation is easy.

Open method
The open method is convenient for burns of the face and perineum. Flamazine was spread over the burned surfaces, which were left uncovered. The contact of the agent with the unburned skin was painless and safe. Dressings were changed in most cases every 24 hours during the first 10 days post-burn, and every 24-48 hours thereafter. When necessary, dressings were changed more frequently. With the open method of treatment the agent could be changed more often, i.e. every 6-12 hours. The easiest and most painless way of removing Flamazine from the wound surface was to wash it out with sterile solution or water.

Results

Clinical observations
All the patients were cured: the out-patients and thirtyone of the in-patients after non-surgical treatment, and nineteen of the hospitalized patients after surgical treatment. Sixteen of these nineteen patients underwent early surgical necrectomy between days 3 and 6 post-burn, while the remaining three were operated on ten and more days after the accident. Spontaneous epithelialization of superficial burns took place in the generally accepted terms, in relation to the depth of the injury.
The maintenance of no or low-level bacterial contarnination of the wounds and the prevention of inflammation allowed early operative treatment and good epithelialization of the wounds.
According to our observations, the eschars in deep burns were soft, slightly moist, metal grey in colour, and with no inflammation area in or around them or any bacterial growth, this making it possible to perform early surgical necrectomy. When this was not done, the separation of the eschars was performed gradually, layer by layer, until full removement, without any sign of local infection.
With regard to superficial burns, after Flamazine application the wounds were covered with a heavy purulent exudation, which gave the false impression of a worsening of the burns appearance. The exudation was in fact sterile and simply the result of the wound exudation mixing with the topical drug. It was easy to remove and there was no sign of any real worsening of the wounds. Deep dermal burns were sometimes covered with a thin coating of Flamazine, mixed with proteins, dissolved in the wound exudation. These coatings were easily removed by scraping them away or cleaning up during subsequent medications. After repeated application of Flamazine the burn surfaces became fresh, with no unpleasant smell or any sign of infectious complications. This was due to inhibition of bacterial growth and the wounds improved condition. As a result, a good process of epithelialization initiated after debridement.

Microbiological results
The bacteriological results in 35 patients are presented in Table 3 and Fig. 1. It was established that:

• in 27 patients (77.0%) the wounds remained without bacterial growth from the time of the patients' admission until the operation or epithelalization of the wounds in 4 patients (N° 16, 19, 21, 24) (11.5%) the preexisting bacteria were eradicated after Flamazine application, which means that the effect of the agent was both therapeutic and prophylactic

• in one patient (N° 28) (2.9%) the bacterial quantity was reduced and after three medications (day 4) the pre-existing bacterial pathogens were eradicated

• in three patients (N° 11, 12, 27) (8.6%) bacterial colonization of the wounds occurred as follows: Pseudomonas aeruginosa + Acinetobacter sp., days 3 to 5 (N° 11); Staphylococcus aureus, days 3 to 8 (N° 12); and Serratia sp., days 6 to 10 (N° 27). The bacterial quantities in all three cases were below the significant value; no clinical signs for local or systemic infection appeared, and the skin grafting and healing processes were not disturbed

three patients developed staphylococcal bacteraemia, due to Staphylococcus aureus in two patients and coagulase-negative staphylococei in one. The origin in each case was contaminated central venous can~ nulae; there were no cases of generalization of local infection (burn wound sepsis)
The results were evaluated as follows (Fig. 2):

• very good - 31 cases (88.5%)

• good - 4 cases (11.5 %)

• unsatisfactory - no case

No toxic reactions or other side-effects were observed. The application of Flamazine was painless and comfortahle for the patients.

Fig. 1 - Bacteriological results of Flamazine treatment. Fig. 2 - Evaluation of treatment results.

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