HOW HEPARIN IMPROVES BURN TREATMENT AND RESULTS

• No evidence of clotting of blood.
  
• No complications due to blood clots: (1) No destruction of the blood-deprived tissue beyond the clot (an infarction); (2) No dislodging of a clot that traveled within a blood vessel (an embolus) to form an infarction in a distant organ; nor (3) many emboli forming infarctions in many body organs that was often lethal (named Disseminated Intravascular Coagulopathy).
  
• Pain in burns was relieved within minutes when heparin was dripped or sprayed onto burn surfaces (topically).
  
• Pain in blisters was relieved within a minute when blister fluid was drained and the blister were rinsed with heparin.
  
• Deep in body pain was relieved promptly as heparin was administered by vein, or more slowly relieved by heparin injection into fat below normal skin.
  
• Recurrent lesser pain was relieved again with a lesser amount of heparin.
  
• With pain relieved, no pain medicine was needed. No morphine, dilaudid, demerol, or codeine narcotics. Therefore,
  
• Narcotic complications were avoided: No distorted senses; No suppressed breathing or heart function; No decreased intestinal activity; and No addiction.
  
• In addition to relief of pain, other signs of burn cellular-destruction (inflammation) were controlled: the redness was blanched; the heat was cooled, and the burn and body swelling was much reduced. Once relieved they did not return with continued use of heparin.
  
• Swelling in body compartments was less and usually not sufficient to compress blood vessels and stop blood flow within compartments resulting in gangrene requiring amputation; or in loss of nerve function producing a muscle paralysis. Thus Compartment Syndrome was largely eliminated.
  
• Fewer incisions opening skin and deeper tissue to release compartment pressure (fasciotomies) were performed.
  
• Inflammation itself was controlled and stopped: burns did not increase in size as previously observed without heparin. A study of 3rd degree experiemental burns showed that with heparin use the burns consistently decreased in size and depth to an average 71% of original size at 9-11 days. In contrast, without use of heparin, the burns increased in size and depth for 9-11 days, to an average 121% of original size. This initial 50% advantage with heparin persisted into final healing.
  
• Burn blisters were not removed (debrided). Blisters did not become infected as a rule. The blisters functioned as natural skin grafts under which smooth new skin was evident when the thin dried blisters fell (flaked) off.
  
• At 24 hours, heparin-treated burns were smaller in size by measurement, drier, had less or no pain or swelling, and in some burns an early return of blood to blood deprived and deficient tissues was evident (revascularization).
  
• Saliba described production of new blood vessels and a return of blood to blood deficient tissue, called neoangiogenesis, before neoangiogenesis was a known effect and property of heparin. Neoangiogenesis is the migration of the single cells that forms the wall of the smallest blood-vessels (capillary endothelial cells) into a blood-deficient body area (ischemic tissue), and multiplication of the endothelial cells which then connect-up to form new capillaries which carry blood and restore blood-flow into the ischemic areas, enabling healing for which blood circulation is vital. In 1973 in JAMA, Journal of American Medical Association, Saliba stated: “Unexpectedly, small blood vessels appeared in some thick avascular white eschar. Red comma-sized and comma-shaped structures, randomly arranged at first, increased in length, number, and proximity; joined in a rudimentary vascular vessel pattern; and increased in complexity, number, and proximity until the entire area was densely revascularized erythematous structure that by subsequent granulation and re-epithelialization evolved into healthy healed skin without slough, debridement, skin graft, infection, contracture, or scar.” A blood vessel tumor (hemangioma) in one healed burn area seemed to indicate too much heparin had been used topically. It was nearly 10 years later, early in the 1980’s, that studies proved that heparin was the body’s neoangiogenic biochemical.
  
• Saliba administered oral penicillin or erythromycin antibiotic to all burned patients, who had fewer infections then previous patients not treated with heparin. Increased delivery of antibiotic to burns by the heparin-enhanced blood flow to the burns was one mechanism. Another reason for reduced infections was found 2 decades later - a study showed heparin preserved intestinal structure and reduced translocation (passage) of intestinal bacteria into the body (sepsis) in experimental 3rd degree burns compared to controls without heparin.
  
• With heparin use, fluids needed to maintain vital blood circulation was half.
  
• Saliba described the enhanced amount of highly vascular granulation tissue, whose main ingredient is collagen, without stating the mechanism of heparin-collagen effect, because mechanisms were unknown.
  
• Nearly 15 years later, Drs. KM Ramakrishnan and colleagues in Madras (now named Chennai) India, experimented and found the mechanisms by which heparin stimulated and regulated the production and deposition of collagen in granulation tissue in two phases in burned patients. <link to Ramakrishnan>
  
• Saliba describe enhanced healing with consistently smooth skin without scars and contractures with heparin use topically into healing. As with neoangiogenesis and enhanced granulation tissue, no mechanism(s) for the heparin production of smooth skin without scars or contractures were stated because mechanisms were not then known. Two decades later, studies found heparin stimulated the production of primitive cells (fibroblasts) to form increased numbers of smooth muscle cells so no contractures resulted. The muscle cells then adequately filled the space below the new skin, so no shortening (contracture) of the skin surface resulted which limited movement. Similarly heparin stimulated increased production of primitive fibroblast cells to form new dermal cells, and aligned their inner structural rods (intracytoplasmic fibrils) in a parallel regular pattern which resulted in smooth skin. In scars the intracytoplasmic fibrils were in a chaotic pattern or in clumps beneath the dermal cell membrane.
  
• The studies were presented in National and International Burn Meetings.
  
• Developed a Heparin in Burns Treatment Protocol available free to download from Website: http://salibaburnsinstitute.org
  
• The Heparin Protocol was presented to and beneficially used by doctors in treating over 30,500 burned patients in 18 countries (by 2007).
  
• Advocated use of heparin in thermal disasters as a first response cost-effective treatment of the many burn victims.
  
• Developed a Heparin Therapy in Thermal Disasters Protocol available free to download from the Internet Website: http://salibaburnsinstitute.org
  
• Organized a Global Heparin Therapy in Thermal Disaster Response System of Doctors experienced in Heparin Therapy in many countries (In each doctor’s link.). These doctors are willing to travel within and adjacent to their countries to sites of thermal disasters and within 2-24 hours consult-assist the local doctors when appropriate in the cost-effective treatment using heparin of the many burned persons. (View Thermal Disasters in Mexico and India link.)
  
• Saliba additionally researched heparin treatment of difficult-to-treat and chronic-non-healing-wounds, ulcers, and skin problems. The evidence is in the U.S. Patents he filled but did not use commercially. Heparin provides cost-effective therapy for these dreaded, costly, disabling, and often terminal ills.
  
• Established the Saliba Burns Institute, a global association of burn-treating doctors dedicated to broadly informing the public and instructing doctors, nurses, and ancillary therapists worldwide in the safe, cost-effective addition of heparin in treatment of burns, wounds, and difficult to treat skin problems.
  
• Sponsored National and International Heparin Effects in Burns Meetings, Conferences, and Symposiums with Workshops. In the future, the meetings will be expanded beyond burns to include wounds and skin problems.

  
  
  See also: A Summary of How Heparin Improves Burns for Patients and Doctors.