Peru

HEPARIN HEALS BURNED PATIENTS : A TWO CASE REPORT

Luis Miguel Polo de la Piedra MD Author. Plastic & Reconstructive Surgery, Trujillo Peru

Michael J Saliba MD., Heparin Consultant & Manuscript, La Jolla CA, USA.

INTRODUCTION   A 6 year of age boy received a painful deep second degree hot water scald burn in his neck and chest of 9% Total Body Area Size, by Lund and Browder estimation.  Burn Case 2. Fig. 2a  He had been surgically treated in the hospital for over 3 weeks, with standard current care including with skin grafts taken from both of his thighs.  The skin grafts were in poor condition, were being lost, and the burn wound had a Pseudomonas infection.  The boy was miserable, unhappy, in pain and subjected to the usual unpleasant burn treatment. 

 His situation was serious. More skin grafts were being planned.  I elected to discharge the boy from the hospital, and I decided to test heparin as a trial treatment added to his care as an outpatient in my office and in his home.

 METHOD Heparin was administered as detailed for Topical Treatment of Heparin in the Heparin Treatment of Burns Protocol in Website: http://www.salibaburnsinstitute.org  No heparin was administered intravenously or subcutaneously.  The heparin was low molecular weight heparin 25 IU/ml solution in 5 ml vials with a spray top. Water baths, debridements, topical sulfa antibiotic cream and pain medicine were discontinued.  Amikacin antibiotic solution was added with heparin solution used topically as in Burn Case 1.  I treated him in my office. A relative treated him using heparin topically three times a day at home.

 RESULTS. Topical use of heparin relieved his pain.  The infection was eliminated. Burn inflammation subsided. Using heparin the burns were revascularized, granulation tissue was produced, lost tissue was restored and the burned surface was epithelialized with smooth skin without contractures or scars.  Some difference in pigmentation was noted. The costs were much reduced. The boy, his mother, relatives, and we therapists were pleased and happy. I considered the results to be spectacular and amazing.  The care outside of the hospital was easy, and the help of the family administering heparin at home helpful in the healing. The results were something dreamed of and unexpected.  The burn evolution using heparin is shown in Burn Case 2, Figs 2c – 2h 

 CONCLUSIONS  Topical heparin treatment simplified and improved burn treatment and results at affordable costs. I think heparin will be useful in helping burn surgeons to relieve pain, accelerate healing, and to decrease scars and contractures.

The use of heparin reduces the number of operations necessary in the treatment of burns. Heparin
resulted in improved healing of injuries difficult to cure. Addition of heparin  improved surgical outcomes, as is evident in the following reports of the surgical removal of facial tumors which then were healed using topically applied heparin.

NOTE: The burned boy was the second patient treated with Heparin. Below is my first experience with Heparin.

INTRODUCTION   An age 30 female sustained a direct fire flame deep 2nd degree burn of her face and neck of 4.5% TBS size, and of her left arm of 6% TBS size by Rule of Nine estimation.  She received hospital standard current surgical and medical burn treatment for 4 weeks without “great results”. That is, she had little healing on a time-of-care basis.  Burn Case 1, Figs 1a.

 During the time she was in the hospital, a Heparin Therapy in Burns Symposium in Lima Peru reported favorable results adding heparin.  I talked to the presenters, Drs Alberto Reyes Escamilla and MJ Saliba, discussed the treatment with them, and viewed the Heparin Internet Website: http://www.salibaburnsinstitute.org.  I studied the Protocol on the website. To my knowledge heparin had not been used topically in burns in Peru.  This patient needed treatment improvements. So, I took the opportunity to test heparin.

 I decided to add heparin to her burn treatment, and she was discharged from the hospital. Honestly, I did not have confident expectations as I entered into what I then thought and said was the “almost unbelievable fantastic world of heparin therapy.”  I did hope heparin might produce faster healing and better results. I thought heparin would relieve her pain and the cost  certainly would be less.  

 

 METHOD  She was discharged from the hospital, and I treated her in my office and in her home.   

5 milliliters of a solution of 25 IU/ml of low molecular weight heparin was topically applied

three times a day on the burn surfaces, and allowed to dry, prior to covering with a gauze dressing. Heparin was administered on top of and through the gauze on subsequent topical applications.  Starting Day 3 of this treatment, Amikacin 500 mg in solution was applied to the burns topically along with the topical heparin solution.  She was initially treated in my office and she returned every five days.  She was similarly treated using heparin in similar topical manner at home administered by a relative.  Contact with the patient was made daily by telephone. Heparin treatment began on November 8, 2010 and was completed January 6, 2011.  No additional treatment was given.  No skin grafts were performed.  No water baths of the burns.  No pain medicine. No sulfa topical cream.

 RESULTS  Using heparin she had no pain, accelerated healing, and smooth comfortable skin. The result were amazingly good in my opinion. The cost was much reduced.   Case 1, Figs 1b-1g  .

 CONCLUSIONS  Heparin added topically healed her burns, improved treatment and results, without pain, with faster healing, and at considerable lower costs. Adding heparin to burn treatment is recommended, when there are no contraindications.

Using heparin will reduce the number of surgical operations needed in treating burns.  Heparin however has increased my surgical practice and resulted in improved healing of difficult to heal lesions. 

Adding heparin along with surgical procedures improves the results, as is evident in the following reports of 2 patient resection of their facial tumors. 

 HEPARIN HEALS RESECTED NEOPLASM FACIAL SITES: A TWO CASE REPORT

Luis Miguel Polo de la Piedra MD Author. Plastic & Reconstructive Surgery, Trujillo Peru

Michael J Saliba MD., Heparin Consultant & Manuscript, La Jolla CA, USA.    .   

INTRODUCTION   Resection of facial tumors with free margins are difficult surgical management and esthetic plastic surgery challenges; especially when the neoplasm is at the eyelid margin or is at the eye nasal-angle.  Heparin therapy of burns and difficult-to-treat or chronic medical lesions was shown to result in smooth skin consistently without scars and contractures.(1)  Therefore, after 2 trial heparin treatments in 2 burned patients produced similar results(2), heparin solution was topically applied to each of those surgically resected tumor sites. Case Photographs, Figs 1a-c and 2a-f.

 

 

METHOD  Patients had prior tetanus immunization.  Each tumor was resected using geometric incisions with free-of-tumor margins under local anesthesia, using lidocaine 2%, ice, and epinephrine. Figs 1b and 2b.  The eyelid site was loosely approximated by a single stitch, Fig 1b.  25 IU/ml low molecular heparin solution was topically applied three times a day (TID) initially before and then through a sterile dry gauze dressing. The solution dried on the resection site.  Levofloxacin antibiotic was orally given 500 mg daily for 5 days. Then 2 ml of 250 mg/ml of amikacin solution mixed with the heparin solution was dripped topically TID on the open surgical healing area until epithelialization was complete, by me in my office and mostly by a family member in the patient’s home.  The treatment was otherwise dry.

RESULTS  Using heparin, there were no signs of inflammation.  No significant pain, erythema, or swelling.  A small amount of blood spread from the post-operation resection site into the lower eyelid in Case 1 and  the upper medial eyelid in Case 2. No infection developed.  Each surgical resection site treated with heparin progressively was revascularized, granulation tissue was formed, epithelialization occurred, and healing with full thickness skin resulted.  The healed surface was smooth.  Case 1 was healed in about 18 days. Case 2 was healed in about 35 days. No contractures formed as of 3 months post-treatment.  Cosmetic results were pleasant. Figs 1c; and Figs 2c to 2f.

DISCUSSION   Tumor resection sites can sometimes be a vicious open wounds that requires grafts, flaps, and revision operations, involving adjacent areas.  Contractures can mar results.  Cosmetic results may esthetically be suboptimal. Post resection topical application of heparin resulted in medical healing in these 2 cases.  Although no additional surgical procedure was required in these two cases, a lesser number and amount of surgical procedures may be added when and if needed, under improved conditions produced by the heparin therapy.  The surgical resection of tumors and heparin medical healing of the surgical site improved the care and results of facial tumors involving the eyelid and eye nose-angle area. The addition of heparin was a new therapeutic treatment advance in these cases:  Progression in open-tissue healing was faster, the results were remarkably and amazingly good without displacement of tissue, with less scaring, and at less cost, all with better esthetic results, without contractures.  Heparin applied topically was easy to utilize with the help of the family providing care in the patient’s home.  .

CONCLUSION  Adding heparin in the healing phase of surgically resected facial tumors around the eye improved treatment, functional and esthetic results, and lowered costs.

Address correspondence to:

LUIS MIGUEL POLO DELA PIEDRA:   dermedstheticperu@yahoo.com

With Cc to info@salibaburnsinstitute.org


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