Dr. Chona Thomas MD, FRCS, FACS Plastic Surgeon, Head of Department of Surgery and Plastic Surgery, Muscat, Oman
Dr C. Thomas and 20 doctors in the National Burns Centre, Khoula Hospital, Muscat, Sultanate of Oman have used the Heparin in Burns Protocol starting in 2003 on 125 +/- burned patients per year, a total of over 700 patients:
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50% children and 50% adults, involving females more than males because incidence of domestic burns is considerably higher than other types of burns.
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Age range 3 months to 60 years.
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We use heparin administered only topically.
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Heparin improves care and reduces procedures.
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Cost is difficult to assess, even though heparin is cheaper it requires more nursing care as we use topical application three times a day, whereas dressing with 1% Silver Sulphadiazine needs only daily application. However, the end result at time of discharge is considerably and appreciable better with heparin therapy than with 1% Silver Sulphadiazine therapy.
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Our group of 20 doctors and 40 nurses are all convinced by the beneficial effects of heparin such as
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(1) excellent healing of the burn patients,
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(2) depth of the burn wound may be reduced,
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(3) analgesic property of heparin is a great beneficial factor for the children. Since they are very comfortable with heparin therapy, and are not complaining of pain, the administration of the analgesics and sedatives are considerably reduced,
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(4) Proven beyond doubt that heparin therapy is a great help in the first and second degree burns. In the past, we were performing skin grafting for the second degree burns also in order to reduce the hypertrophic scar formation. By the regular topical application of heparin to the second degree burns, surgical intervention such as skin grafting is not required and the quality of the scar is considered as excellent.”
See abstract below
TOPICAL HEPARIN THERAPY FOR BURN TREATMENT in OMAN
Chona Thomas, Head of Oman Plastic Surgery, Sultan Qaboos University College of Medicine. Khoula Hospital: National Referral, Surgery Care & Training Center.
Approved Plastic Surgery Training Center by Edinburgh Royal College of Surgeons
INTRODUCTION Our 80 bed Hospital, 20 doctor, 12 bed Burn Unit started adding Heparin Therapy to burn care following presentations by MJ Saliba, USA, and KM Ramakrishnan and J Venkataraman, Chennai India, at the 2002 Oman National Burn Conference, Muscat. In a study from January 2003 to January 2006 a total 416 children and adults, with burns frorm 2% to 90% burn surface area were treated by the topical application of heparin. 177 patients were treated in the next 18 months.
METHOD:Though heparin can be given parenterally, our use is mainly topical application 3 times a day at 8 hour intervals, onto the one layer paraffin gauze dressing, changed once daily. We start the heparin added to the dressing from the time of admission. The heparin added onto the dressing each time is 5000 IU heparin/10Kg body weight/15% burn area size. The 24 hour heparin is 15000 IU/10Kg/15% burns. Our past routine use of 1% silver sulfadiazine ointment topically is limited now to infected burns, especially pseudomonas, in burned patients transferred from other Oman hospitals. A coagulation Panel is done on admission and repeated every 3rd day. RESULTS No significant alteration in coagulation was found with use of heparin topically. Heparin Advantages Over Silver Sulfadiazine are the following: (1) Heparin reduces pain so use of analgesics and sedatives were reduced considerably, especially in children. (2) There is steady healthy healing with epithelialization noted in 1st and 2nd degree burns. (3) Rapid formation of healthy granulation tissue in 3rd degree burn wounds. (4) Easy monitoring of vascularization of the digits while using hand bags. (5) the number of tangential excisions and skin grafting are considerably reduced using topical application to the burn wound. (6) Patient compliance is high and patients prefer heparin topical application rather than Silver Sulfadiazine. Consistent Results Using Heparin: Profound analgesia, better healing in first and second degree burn wounds, rapid formation of healthy granulation tissue in third degree burn wounds, better patient compliance and easy monitoring of the vascularity of the digits while using hand bags, reduction in the skin grafting operations of the burn wound are the major advantages obtained by the heparin therapy, in our experience. Consistent observations: Good pain relief. Good scar. Good colour match. Less hypopigmentation and less hyper pigmentation. Good patient compliance with dressing. Less pain during dressings. Reduced number of surgeries. Easy monitoring of vascularity of the digits. Difficulties in terms of patient care are the need to add heparin 3 times a day; and the need for constant vigil over coagulation.
USA, INDIA, RUSSIA, BULGARIA, EL SALVADOR, BRAZIL, MEXICO, HAITI, OMAN, CHINA, SOUTH KOREA, NEPAL, ITALY, PARAGUAY, BELGIUM, PERU, CHILE, SOUTH AFRICA
