India

 

 

 

In 1988, the widely known, and much respected Plastic Surgeon Dr. K M Ramakrishnan from India and Dr. M J Saliba from the USA each presented studies in Istanbul, Turkey, at the Recent Advances in Burn Treatment, International Society for Burn Study Congress.

At a quiet moment, Dr. Ramakrishnan said, “I have wanted to meet you, Dr. Saliba, for some time, because I want to tell you that your treatment of burns with heparin works, and it works exactly the way you say it does.” 

Dr. Ramakrishnan and 9 colleagues, including Drs. V. Jayaraman, Sri. Ramachandra, K Ramachandran, and Director of Research M. Babu have treated over 800 patients a year since 1981, using heparin solution topically, systemically inside the body, and in fetal and collagen membranes placed on burn surfaces treated with heparin. Having treated over 20,000 burn patients from age 10 days to 93 years, they report the following results: 

  • Heparin improved care, is cost effective, and there is good healing. 
  • Consistently found significant benefits similar to Drs. Saliba, Kruggel, and Mangus with use of heparin comparing studies of 30 or 100 burned patients treated with heparin compared to 30 or 100 similar burned patients not treated with heparin. 
  • Used antibiotics in all patients because of the high temperature and humidity in India. Used diluted solutions of heparin in larger volumes topically. 
  • Used heparin soaked membranes to cover burn surfaces previously treated with heparin and reapplied them until burns were healed. 
  • Found and proved that the mechanism for enhanced and shortened healing of burns in the middle granulation phase was heparin effect on collagen fibers in the burn wound in 2 distinct sequential patterns:

1st, heparin significantly accelerated the production and deposition of collagen in the burn wound in the first phase. 

Then, heparin decelerated production and actually increased the re-absorption of collagen in the 2nd phase, so as to prevent an accumulation of collagen that would be a raised fibrous scar in the healed burn. 

  • "Use of heparin has enabled us to treated more burned patients. In India, prior to use of heparin, the cost of treating burns of more than 25-30% size was so prohibitively high and unsustainable by the Government, that those patients were given morphine to relieve pain and they died. With use of heparin much larger burns of almost all size are now effectively and affordably treated.” 
  • As a consequence, the Government of India now supplies and sends heparin-collagen membranes to treat the many burned persons at sites of thermal disasters - for example, the horrendous two railway car explosion-fires on the New Dephi India to Lahore Pakistan train act of terrorism in 2007. 
  • Attended and presented studies in SBI sponsored eight Int’l Heparin Therapy in Burns Meetings, Conferences, Symposiums, and Congresses usually accompanied by Assistant Prof. of Plastic Surgery Dr. V. Jayaraman MD, Ms., MCh., MNAMs, Dip.NB., PhD. Government Kilpauk Medical College & Hospital, Chennai India. 
  • Independently and with Dr. V. Jayaraman, presented heparin therapy in burns in Malaysia, Singapore, Bahrain, Kuwait, Australia, Austria, and in cities of Berlin in Germany, Seattle in USA, and Seoul, Korea. 
  • Responded to Thermal Disaster in Bali Indonesia, but unable to assist local doctors as survivors largely were air evacuated to their homeland in Australia.

 

“In India, heparin enables us to successfully treat burns above 30% size in patients who previously died because the costs were unsustainable by our Government.”

 

 

 

India  Pondicherry

A Comparative Study of Burns Treated With Topical Heparin and Without Heparin

Venakatachalapathy TS, S Mohan Kumar, MJ Saliba, Indira Gandhi Government General Hospital and Post Graduate Institute, the Burn Unit, Pondicherry, India.

 

Introduction: Following reports of heparin use in burn treatment [1-16], this ethics committee approved, prospective, randomized study with controls compared results using traditional usual burn treatment without heparin, with results in similar patients similarly treated, and with heparin added topically.

Method: The subjects were 100 consecutive burned patients, age 15-35 years, with 2nd degree superficial and deep burns of 5-45% TBSA size. Two largely* similar cohort groups (C and H) with 50 subjects in each group were randomly treated. *Except, 13 C patients had burns 35-45% size vs. 1 H, (p<.01).  The 50 Control Group patients (C) had traditional usual treatment, including topical antimicrobial cream, debridements, and, when needed, skin graftings in early postburn period. The 50 Heparin-treated Group (H), without topical cream use, were additionally treated, starting postburn Day 1, with 200 IU/ml Sodium Aqueous Heparin Solution, USP, (Heparin) dripped on the burn surfaces and inserted into blisters 2-4 times a day for 1-2 days, and then only on burn surfaces for a total 5-7 days, prior to skin grafting, when needed. Then C and H Group treatment was similar.    

Results: Tables 1-18. The Heparin-treated patients (H) complained of less pain and received less pain medicine than the Control Group (C) patients. H needed fewer dressings and oral antibiotics than C.  Significantly less Intravenous fluids were infused in H, 33.5 liters in 39 H patients versus 65 liters in 41C, nearly 50% less, p<0.04.  The 50 H patients had 4 skin graftings, an 8% rate. The 50 C had 10 graftings, a 20% rate.  5 C patients died, a 10% mortality rate. No H patients died.  Days in Hospital for H vs. C were significantly less, all p<.0001: 58% of H were discharged within 10 days vs. 6% of C; 82% of H were out in 20 days vs. 14% of C; 98% of H vs. 44% of C were out in 30 days; and with 100% of H discharged by day 40, 56% of C required up to another 10 days.  The burns in H patients were healed in 15 days av. (longest 37 days), vs. 25 days av. (longest >48 days) in C, p<.0006.  Procedures and costs in H were much less than in C.  Comparable Photographs of H and C differences are shown.

Conclusions: Heparin applied topically for 5-7 days improved burn treatment: reduced pain, pain medicine, dressings, and antibiotic; significantly reduced IV fluids (p<.04), days in hospital (p<.0001); healing time (p<.0006), and reduced skin grafts, mortality, and costs.

 

USA, INDIA, RUSSIA, BULGARIA, EL SALVADOR, BRAZIL, MEXICO, HAITI, OMAN, CHINA, SOUTH KOREA, NEPAL, ITALY, PARAGUAY, BELGIUM, PERU, CHILE, SOUTH AFRICA