Introduction

The management of the burn wound is aimed at prevention of infection and at the arrest of impending tissue necrosis, so that healing ensues favourably in partial-thickness burns. Superficial partial-thickness burns heal within two weeks without scarring, but deep partial-thickness burns are often problematic. The problem is aggravated by the inherent tendency of these burns to deepen during the first three days post-injury and become infected, developing hypertrophic scars. A healing time extending beyond the third week postburn leads to abnormal scar formation. Wound dressing plays an important role in burn patients in whom spontaneous healing is anticipated. An ideal wound dressing should be easy to apply and remove, stay in place, relieve pain, protect from infection, ntinitnize disruption of the wound bed, encourage re-epithelialization, and be cost-effective. The search for an ideal dressing continues, in burn wound care.
Solcosery10 is a chemically and biologically standardized protein free nonantigenic and noripyrogenie dialysate of blood from healthy veal calves. It contains a broad spectrum of low molecular organic and inorganic substances which help in wound healing by normalizing metabolic disturbances and tissue damage associated with stress injury and hypoxia. The action of Solcoseryl increases oxygen uptake by cells, stimulates ATP synthesis, improves glucose transport, stimulates collagen formation, and promotes angiogenesis. Solcoseryl has a capacity to speed up the return of reversibly damaged cells to their normal state by growth-factor-like activity and cytoprotective effects. Skin wound healing is a combination of cellular and hormonal reactions with scar formation, and scar quality depends on the harmony of the cellular and hormonal reactions. Hypertrophic scar formation is quite common after burns and the use of Solcoseryl is claimed to reduce scarring by balancing the cellular and hormonal reactions. This study was undertaken to evaluate the role of Solcoseryl in burn wound management.

Material and methods

Forty minor burn patients who from February 1994 to April 1995 attended Al-Babtain Centre for Plastic Surgery and Burns (Kuwait) within 24 h post-burn were included in this study. The burn area was mapped out according to the Lund and Browder chart. Burn depth was judged on the basis of various clinical criteria. After initial burn wound swabs had been taken, the area was covered with Solcoseryl and gauze and then bandaged. All patients were treated as out-patients. The dressing was inspected every day and changed if needed - otherwise it was routinely changed on alternate days until complete healing occurred. WouDd swabs were taken twice a week as a part of microbial surveillance. Subjective comments of pain, ease, comfort and tolerance of dressing, as well as objective assessment of the wound condition, swab results and the healing process, were recorded twice a week until complete. Once the wounds had healed, they were reviewed every month for a period of six months to assess scar quality, and photographic records were taken.
The findings were recorded on standardized forms and analysed by age, sex, cause, extent and depth of burn, comfort, ease of use, tolerance, allergies, healing duration, and scar quality in all patients.

Results

Twenty-seven male and thirteen female patients with a mean age of 19 yr (range 1-47) were studied (Table I).

Twenty-six patients sustained scalds, five flame burns, five contact burns, and four had electric flash burns. The extent of burn varied from <=1-12% total body surface area (TBSA), although the majority of patients sustained :<= 5% burns (Table II).

Thirty-eight patients presented dermal burns and two had full-thickness burns. In the patients who sustained full-thickness burns, the extent was less than 1 %. The body parts involved are depicted in Table III - the majority of patients (70%) sustained limb burns. Thirtyseven patients reported that use of Solcoseryl caused no pain and that it was quite a comfortable dressing, while three commented otherwise. The application and removal of Solcoseryl were easy - the dressing did not smell abnormal, and it was easy to observe the healing process. The wound swab results showed colonization of organisms in thirteen patients, but no clinical infection occurred in any of them. No allergic reaction occurred during the course of treatment.

The burn areas healed completely (Table IV) in 7 to 29 days (mean, 18 days).

The superficial dermal burns (Fig. 1) healed in about 11 days, mixed dermal burns (Fig.2) in 19 days, and deep dermal and full-thickness burns (Fig. 3) in 23 days. Thirty-six patients had acceptable scars while four developed hypertrophic scars. Two patients who developed hypertrophic scars had full-thickness burns, which took more than three weeks to heal. Hypopigmentation was observed during follow-up in four patients, and hyperpigmentation in eight. There was no incidence of post-burn contracture and the scars remained stable in all the patients.

Fig. la - Second-degree superficial burn in left foot and toes. Fig. lb - Healed area showing dyschromia. Fig. 2a - Mixed burn in right thigh and leg. Fig. 2b - Appearance after three weeks of Solcoseryl treatment. Fig. 3a - Burn in right arm, mostly deep second-degree deep. Fig. 3b - After two weeks of Solcoseryl treatment.

Discussion

All wound care techniques require planned regular dressing changes, although the interval may vary. Each area of the burn should be washed and debrided thoroughly with each dressing change. It is comfortable for patients if a topical agent can be applied and removed easily, causes no pain, is odour free, and stays on for a long time: we found Solcoseryl altogether acceptable in this regard.
Healing of the burn wound, which depends mainly on its depth and the presence or absence of sepsis, is a cornplex pathophysiological process also affected by a series of other multiple factors such as nutrition, temperature, humidity, circulation, mechanical disturbance, and various growth factors. The burn area has three distinct zones: a central zone of coagulative necrosis, a surrounding middle zone of stasis, and an outer zone of hyperaemia. Progressive dermal ischaemia, resulting in progressive cell injury and cell death, is typical of burn wounds for 24-48 h following the thermal insult. Prevention of progressive ischaemia and its resultant metabolic changes can limit the extent of skin necrosis to the zone of coagulation, and this either prevents or limits deepening of the burn wound.' The comparison in this study between wound healing time and clinically assessed depth shows that the majority of our patients healed in the anticipated period. This reflects the fact that there was no deepening of the burn wound when topical Solcoseryl was used. The improvement of tissue oxygenation by Solcoseryl presumably prevented deepening of the burn wound. The deep dermal burn, and also the smaller full-thickness burn, healed in a reasonable period. This favoured healing can be attributed to good cell oxygenation, improved microcirculation, preservation of cell membrane integrity, and maintenance of the remaining skin appendages caused by Solcoseryl. The study does not suggest that healing occurred faster. We observed in most patients a healthy-looking wound and favoured epithelialization. The incidence of hypertrophic scarring was low in Solcoseryl-treated patients, which may be due to the healthy-looking granulation, the favoured epithelialization, and the balancing of the cellular and hormonal reactions. Scar quality was good, as can be seen in most of our patients (Figs. 1,2). The incidence of post-healing pigmentary disorders was considerable (30%) in this study.
Solcoseryl is easy to use, comfortable for the patient, and good for wound healing. It is therefore recommended in minor burns.

RESUME. Cette étude, effectuée en Kowéit, a pris en considération 40 patients avec des brûlures mineures traités en consultation externe dans la période février-avril 1995 (mâles/femelles, 27/13; âge moyen, 19 ans; limites d'âge, 1-47 ans). Vingt-six patients ont subi des ébouillantements, cinq des brûlures par flamme, cinq des brûlures par contact, et quatre des brûlures électriques. Le pourcentage de la surface brûlée variait de 1 à 12% de la surface corporelle totale, et intéressait principalement les membres inférieurs. Trente-huit patients ont subi des brûlures de la peau et deux présentaient des brûlures minimales à toute épaisseur. Les lésions des membres ont été traitées avec le Solcoseryl@.* La médication avec Solcoseryl était facile à appliquer, confortable et bien tolérée par les patients. La guérison spontanée de la lésion en 7 à 29 jours (moyen, 18 jours) était, dans la majorité des cas, en conformité avec la profondité de la brûlure évaluée initialement. La guérison favorable indiquait que les lésions n'étaient pas devenues plus profondes dans la période successive. Uincidence de la cicatrisation hypertrophique était mineure dans les patients traités avec le Solcoseryl. Les Auteurs concluent que le Solcoseryl est un bon agent topique pour le traitement des brûlures mineures.

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