uidance on Application of MEBO Wound Ointment

wers Discretion: The section contains discretional information and is intended for medical professionals only]

ollowing instructions illustrated the standard practice and outcomes experienced in MEBO treatment. For the investigational use of MEB

S, please refer to specific clinical study protocol where the clinical procedures are specifically defined and standardized.

MEBO Application in 1st Degree Burns 1. First degree burn: skin redness, slight swelling and painful.

2. Apply MEBO immediately after injury. With the absorption of MEBO, pain is relieved and edema is diminished gradually. Skin color may return to normal in 12 hours. Continue applying MEBO 2-3 times a day.

3. Burned skin would heal in 2-4 days. Continue applying MEBO as a protective ointment for about one week. For burns with edema, the epidermis is partially destroyed, the pain may be relieved slowly and the cornified layer of skin exfoliates.

MEBO Application in Superficial 2nd Degree Burns

1. Apply MEBO to the wound at 0.5-1 mm in thickness; puncture the blister (if present) on the lower part to discharge liquid, retain the blister skin un-removed; apply MEBO on the blister skin 3-4 times daily.

2. In 3-4 days, the blister skin is loosened and exfoliated; gently remove and clean away the blister skin, then apply MEBO immediately.

3. A thin layer of clear exudate may be seen on the wound bed. Do not need to remove. Do not mistreat it as infection.

4. During the wound cleaning and reapplying MEBO, avoid causing pain or further injury to wounds. Smear MEBO in the direction along with fine hairs to avoid stimulations.

5. Alternatively, sterile gauze could be used to absorb the liquefied exudates for 30 seconds -1 minute.

6. Gently remove the gauze in a tangential direction to avoid causing pain and injury to the wound.

7. Clean the exudates completely before each redressing with MEBO.

8. Evenly apply MEBO on the cleaned wound by 0.5-1 mm in thickness.

9. Wounds would heal in 6-8 days. Continuously apply MEBO as a protection for about 7-10 days until skin functions are fully restored.

MEBO Application in Deep 2nd Degree-Superficial Subtype Burns

a. Burn wounds of superficial 2nd degree burns mixed with deep 2nddegreesuperficial subtype burns on the 1st day after injury. Puncturing the blister and discharge the liquid without removing the blister skin. b. Applied MEBO directly to the wounds. c. On day 3. Edema gradually diminishes; a yellowish thin membrane usually forms on the wound surface. The membrane still allows the underlying exudates oozing through. Protect this layer when clean up the wound, since it can temperately protect wound.

d. On day 4, superficial 2nd degree burn wounds has started to heal. Meanwhile, necrotic tissues of deep 2nddegreesuperficial subtype burns on waist and back are liquefied. Redressing MEBO every 4 hrs in daytime and every 6-8 hrs in night time. Remove the thin membrane. e. On day 8, the wounds of superficial 2nd degree burn wounds has been healed completely. The wounds of deep 2nddegree-superficial subtype burns have been totally liquefied. Removed the loosened or exfoliated blister skin. f. Enlarged view of the 8thday after burn.

g. On day 12, most of the necrotic tissues on deep 2nd degree-superficial subtype burns have been liquefied and discharged. There is a thin fiber membrane formed on the wounds and the wounds have started to heal. h. On day 15, most wounds have been healed. i. On day 25, all wounds have been completely healed. Continue applying MEBO as a protection to new skin for 10-15 days until the skin functions are fully restored.

MEBO Application in Deep 2nd Degree-Deep Subtype Burns

1. After simple debridement, immediately apply MEBO to protect the wounds, and redress MEBO by the same procedure described insuperficial subtype.

2. On 5th 7th day postburn, gently remove the blister skin. Necrotic tissues start to be liquefied and discharged. A thin soft fiber membrane is formed on the wound under the actions of MEBO. Continue applying MEBO and protect the thin soft membrane.

3. On the 20th day postburn, wound healed with regenerated skin.

4. Continue applying MEBO as a protection for 10-15 days. Hypopigmentation is noted.

MEBO Application in Superficial 3rd Degree Burns

a. Patient with facial burns after exposure to flame. No pain sensation, no exudates are observed. b. Histological examination of burn wounds shows fullthickness burn injuries. c. Perform wound ploughing with a specially designed sawtooth cutter on burn wounds in the early stage to release tensive pressure on underlying vital tissues. Plough dry and leathery skin till minor bleeding.

d. Apply MEBO directly to the ploughed wounds. e. On day 2, after cleaning the burn wounds, repeat wound ploughing till minor bleeding on wound. Redress MEBO every 46 hrs. f. On day 12, a typical view of the liquefaction process of necrotic tissues. Do not mistreat this process as wound infection.

g. On day 18, the necrotic tissues are mostly liquefied and painlessly discharged; meanwhile the subcutaneous tissues are promoted to grow. h. On day 27, some burn wounds have been healed with regenerated tissues while other burn lesions are going through healing process. i. On day 50, most burn wounds healed with physiologically regenerated new skin. Note the symmetrical smile; no scarring on face; full sensation recovered.

j. On day 72, all wounds have been functionally healed.

MEBO Application in Deep 3rd Degree Burns 1. The patient has 85% TBSA 3rd degree burns. Wound pathological exam shows full thickness necrosis (fig a, b, c).

2. Wound ploughing is performed for relieving pressure on underlying tissues by using specially designed sawtooth cutter, followed by MEBO application.

3. Clean up the liquefied necrotic tissues before redressing MEBO. The pathological section shows new skin structure has been rebuilding on day 20. (fig e, f)

4. On day 25, numerous skin islands have emerged from regenerated skin tissues.

5. In the skin island, regenerative cells from subcutaneous tissue are robustly multiplying. Note capillaries, collagen, and epithelial cells.

6. Skin islands gradually extend and merger together.

7. On day 49, regenerated skin exhibits the normal skin structure in pathological slide.

8. On day 72, burn wounds have been healed completely with regenerated skin.

MEBO Application in 4th Degree Burns

a. Appearance of burned tibia of left leg. b. Surgical excision of the necrotic tissues on bone surface. c. Removal of the necrotic periosteum and outer cortex of tibia with scraper and bone chisel. d. Multiple holes drilled on the exposed tibia surface in 1.0 cm apart; deep to viable marrow cavity; minor bleeding is expected.

e. Appearance of tibial surface after drilling. f. Subsequent to the application of preserved gauze soaked with MEBO to cover the wound; small granulating buds grew up through the drilled holes within few days. g. Continuous treatment with MEBO, the granulated tissues developed and spread to form a granulated wound. Skin grafting was then performed to close the wound.

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