Ulcer wound therapy
The therapeutic Keypoints of Regenerative Restoration Therapy (MEBT/MEBO) in the treatment of various kinds of ulcer wounds
4.1. The Clinical Therapertic Keypoints of Regenerative Restoration Therapy in the Treatment of Bed Sores
Bed sores also call pressure sores. It is an ischemia injury as a result of the persistent pressure on the bone prominent area that causes the circulatory deficits, ischemia and necrosis. Prof. Xu Rongxiang, the renowned Chinese life scientist proposed in the end of 1980s: All lesions on the body surface belong to the study range of medicine of burn, wounds and ulcers. According to this theory, there have been many reports that successfully treat bed sores with the application of MEBO over the last years. Now that the therapeutic principles of bed sores are briefly analyzed from the angle of regenerative medicine on the basis of the reason leading to bed sores.
The treatment of bed sores is a tough problem in clinic. The traditional way is time-consuming and laborious with long-term course of disease. With the foundation of in situ regenerative medicine by Prof. Xu Rongxiang and the continuous progression of clinical studies and the wide-range application in the treatment of wounds and ulcers, significant clinical efficacy with MEBT/MEBO to treat bed sores have achieved. The clinical therapeutic procedures and key-points as following:
4.1.1. Thorough debridement: For the bed sores, especially classified as III and IV degree bedsore, the affected area including dermis, subcutaneous tissue, muscle, tendon and even bone has already been necrotic. This deep necrotic tissue is hard to be dbrided with the application of MEBO in the short term. Therefore, the surgical procedure is necessary to be performed to get rid the occupied necrotic tissues of the wounds to provide the space to the regeneration of potential regenerative cells (PRCs) and the exogenous life regenerative nutrients(MEBO Wound Ointment) facilitating the growth of PRCs.
4.1.2. The patency of drainage: For I and II degree bedsores, MEBT/MEBO can be adopted with the frequency of dressing-change for once per 4 to 6 hours or change the dressing with MEBO Wound & Ulcer Dressing once per day; for III and IV degree bedsores, due to the possible formation of hidden cavity, the wound opening should be enlarged and the drainage should be complete. It should use the MEBO strip to change the dressing at the early stage. It should not exert excessive pressure on the base of wound in order to leave certain space for the growth of the granulation tissues, and the opening should be tightly closed to prevent the formation of dead cavity. Dressing-change should be once per 8 to 12 hours. During the process of dressing-change, only use the NS or cotton ball with little saturation of NS to gently wipe off the exudates, liquefaction, remnant ointment and etc. It is contraindicative of the application of hydrogen peroxide, antibacterial agents or any agents irritating the wound beds to perform the dressing-change. The wound will be gradually filled with granulation tissues. And when the level of granulation tissues is the same or slightly lower than the surrounding skin, it can be changed to use MEBO Wound & Ulcer Dressing, once per day for dressing-change until the healing of the wound.
4.1.3. Anti-infectious therapy: For those without the signs and symptoms of systemic infection, it should avoid local and systemic administration of antibiotics; for those with apparent S/S of infection, depend on the results of the exudates bacterial culture result and drug sensitivity test as much as possible to choose the individualized antibiotics.
4.1.4. Eliminate the causative factor: Never exert any continuous pressure on the affected area. The air mattress can be used.
4.1.5. Nutritional support: Correct anemia and hypoproteinemia and offer high-protein and high-fiber diets.
4.2. Clinical therapeutic key-points of MEBT/MEBO in the treatment of Diabetic foot
The definition of diabetic foot by World Health Organization is that lower extremities infection, ulceration and deep tissue damage on DM patients are caused by the neuropathies and various extents of distal vascular disorders. Due to the long-term effects from high-level of blood glucose, the vessels in the lower extremities harden with thickening of the vascular wall and decreased elasticity that is easily to form the thrombosis and gather into plague. At the end, result in the obstruction of lower extremities and the injuries of distal nerve endings that cause the lesions on the lower extremities. And foot is the most distal part from heart. Therefore, the most severe condition occurs on the foot. It is extremely susceptible to trigger the formation of swelling, blackening, decay, and necrosis and form the gangrene of toe. The major complications of diabetic foot are foot ulcers and amputation. At present, amputation is the most frequent way in modern medicine to be used in the treatment of diabetic foot.
The treatment of diabetic foot and ulcer is the world-wide tough problem nowadays. And currently there have no effective medicines and treatment. MEBT/MEBO is provided as a solution to this tough problem. It makes use of the way of in situ cell and tissue regenerative cultivation that provide the regenerative nutrients to the non-healing area and regenerate new tissue in short term to heal the wound.
The treatment of diabetic foot and ulcer includes systemic treatment and local wound treatment. The systemic treatment means to control the level of blood glucose and urine glucose with the normal range that facilitates the wound healing and effectively and timely control the infection. But the correct treatment on local wound will directly influence the velocity, quality and prognosis of the ulcer healing. Many clinical reports attested to the significant efficacy of MEBT/MEBO in the treatment of diabetic foot. The key-points of local wound treatment as following:
4.2.1. Chronic inflammatory infectious stage: the course of diabetic foot is long with the existence of rejection on the necrotic tissues. The surrounding normal skin is red and swelling. The wound secretion and exudates have special odorous smelling. The wound bed contains yellow or blackened necrotic tissue with pale and ageing granulation tissues. There are chronic inflammatory changes: the formation of fibrous ring or board around the wound or on the base of the wound. At this stage, the key interventions are:
(1) thorough debridement: apply MEBT/MEBO to dbride the necrotic tissues on the wound as soon as possible. Change the dressing with MEBO Wound Ointment and / or MEBO GauzeMEBO Wound & Ulcer Dressing 2 to 3 times per day to as soon as possible remove those necrotic tissues in the way of liquefaction from distal to proximal; The liquefied necrotic tissue should be removed firstly, them the non-liquefied; The dead soft tissue (skin and tendon) should be removed firstly, then the dead bone; after the inflammation is completely subsided or controlled with the apparent distinction between necrotic and normal tissues, then the necrotic tissue is thoroughly removed. But it should caution the local blood circulation. The diabetic foot and ulcer wound, especially for those classified as III and IV degree, the affected area (skin, subcutaneous tissues, muscle, tendon and bone) have been dead. Some even have occurred purulent tenosynovitis. At this time, if the purulent tendon sheath could not be timely opened, infection is likely to spread from the distal to proximal. Therefore, it must depend on surgical procedures to remove these occupied necrotic tissues. For those associated with purulent tenosynovitis, it should incise the wound from distal to proximal to fully expose the purulent and necrotic tendon sheath and tendon so that as quick as possible remove affected parts directly and prevent from the spread of infection. Hence, thorough debridement is a significant intervention to prevent local infection, promote the growth of granulation tissue and accelerate the healing process. The concrete operations: for the dry necrotic tissues, it is better to firstly apply MEBT/MEBO that is smearing topically MEBO Wound Ointment 2 to 3 times per day to promote the softening and liquefaction of necrotic tissues, then perform the surgical procedures to dbride the necrotic tissues for once or more than once.
(2) The patency of drainage: for those classified as I and II degree, it can apply MEBT/MEBO to change the dressing, once per 8 to 12 hors or MEBO Wound & Ulcer Dressing once per day; for those classified as III and IV degree formed in the gangrene stage of diabetic foot, as the wound reaches to the subcutaneous tissue or bone, there have always the formation of undermining or tunneling with different sizes and shapes. It is better to use MEBO gauze to change the dressings and maintain the drainage. During each dressing-change, the MEBO gauze should be placed on the base of the undermining or tunneling without any space left. Additionally, the pressure of MEBO gauze on the base of the wound should not be too much to leave sufficient room for the growth of granulation tissue. And it should compress wound opening to prevent the formation of dead space. Change the dressings once per 8 to 12 hors. During each dressing-change, only the cotton ball wiping NS (normal saline) can be used to gently remove the exudates, liquefaction, remnant ointment and etc in the wound. It should avoid applying any impairing disinfectants such as hydrogen peroxide, antibacterial agents and etc.
4.2.2. Repairing stage: after the debridement of necrotic tissue and growth of granulation tissues, the wound steps on the repairing stage. At this stage, it should protect the granulation tissue to promote rapid regenerative restoration and healing of the wound. The key-point interventions during this stage are:
(1) The singular application of MEBT/MEBO: for those classified as I and II degree that enter into repairing stage, the frequency of dressing-change should be decreased. It can apply MEBO Wound & Ulcer Dressing to change the dressing once per day. Or apply Moisture Semi-exposed Therapy with MEBO gauze, with the dressing-change 2 times per day. The wound can all be healed.
(2) The application of MEBT/MEBO combined with micro-skin transplantation: for those classified as III and IV degree, if the surface area of the wound is large with the diameter of the wound larger than 20 cm, the wound can be continuously treated with MEBT/MEBO (that is to use MEBO Wound & Ulcer Dressings, once per day for dressing-change)in the repairing stage in order to shorten the course of disease. Or apply Moisture Semi-exposed Therapy with MEBO gauze in association with micro-skin transplantation to change the dressing 2 times per day that will accelerate the healing process. 
4.2.3. Systemic therapy:
(1) Anti-infectious therapy: As long as no signs and symptoms of systemic infection, the antibiotics should be avoided locally and systemically. For the one with apparent signs and symptoms of sepsis, the antibiotics can be chosen in accordance with the results of secretary culture and drug sensitivity test to be administered systemically for 5 to 7 days. After the recession of the inflammation on the wound, it can be stopped. 
(2) Eliminate the causative factors: through the reasonable diet restriction, offer the low-carbohydrate, low-lip, high-protein, high-vitamin diet. For the food containing starch, the amylopectin foods or those with the Glycemic Index (GI) lower than 55% should be taken much more percentage; Administer antihyperglycemics or Insulin to maintain the level of blood glucose within the targeted range. Meanwhile, administer Chinese traditional medicines to promote the blood circulation and prevent blood stasis or (and) the vasodilators, such as Prostaglandin and etc.(3) Nutritional support: correct anemia and hypoproteinemia.
4.3. Therapeutic key-points of MEBT/MEBO in the treatment of severed fingers
Severed finger indicates the dissociated injury on finger, including the completely severed and the complete amputation of bone, muscle, nerve, vessel, soft tissue and skin. At present, the amputation replantation is adopted in the treatment of this injury. But for the amputation on the fingertip, as the affected vessels are too small and distal, the administration of microvascular reanastomosis is hard to realize the viability of the severed part. Having no alternative method, the destructive sealing technique has to be performed with permanent disability left. Over the last decade, there have had multiple nationwide report about the successful treatment of severed fingertip with MEBT/MEBO that had realized the regeneration of severed part3. The clinical therapeutic key-points as followed: for the amputated injury admitted at the early stage, after performing routine cleansing procedures, the ligation or clamping of the bleeding vessels should be firstly performed to keep the bleeding under control; then, apply MEBT/MEBO on the wound that create the regenerative environment for the severed area. Frequency of dressing-change: 4 to 6 times per day with Moisture Exposed Therapy; 1 to 2 times per day with MEBO Wound & Ulcer Dressing. During each dressing-change, the blackened or yellowish necrotic tissues and liquefaction should be removed to maintain the cleanness of the wound and promote the quick in situ regenerative restoration of amputated part.
4.4. The treating keypoints of Regenerative Restoration Therapy (MEBT/MEBO) in the treatment of crush injuries, hot-pressing and high-voltage electronic injuries and orthopedic wounds and ulcers
4.4.1 For the crushed, hot-pressured and high-voltage injured wounds, the debridement in order to incise and relieve the tension should be performed as soon as possible after injuries. All of necrotic dermal and subcutaneous tissue should be incised as soon as possible to open the fascia (that is to say, to perform fasciotomy and limited debridement). The limited debridement means removing the apparent necrotic tissues and keeping the tissues that still contain normal and healthy cells. Then, administer moisture exposed therapy (Do not bandage the wound). The frequency of dressing-change is 4 times per day. During each dressing-change, only the limited debridement would be performed. Before the arrival of peak rejection and infection stage, remove all necrotic tissues to promote the in situ regenerative healing of the wound.
4.4.2. For the wound with bone and tendon exposure due to various reasons, if the skin flap is inappropriate to be given or the failure after skin flap, the bone marrow windowing procedure should be taken. And thoroughly remove the exposed yellow and blackened necrotic tendon and keep white and fresh tendon. Then, offer the moisture exposed therapy---one regional therapy of MEBT/MEBO. Generally speaking, granulation will be growing out and surround the exposed white fresh tendon one week after the windowing procedure.
4.4.3 For the wound after fixation due to fracture with the exposure of steel plate. It can remove the exposed steel plate and give external fixation at the distal and proximal part of fractured bone. And then, remove the necrotic tissue on the exposed bone wound and perform the windowing procedure in association with Regenerative Restoration Therapy (MEBT/MEBO) to repair the wound.
4.5. The therapeutic key-points of MEBT/MEBO in the treatment of various kinds of surgical sites
The scarring on the surgical sites is unavoidable after varieties of operations. With the application of MEBT/MEBO, varieties of surgical sites can be in situ regenerated and restored without scar left4. The therapeutic key-points: the running or continuous stitch is as much as possible adopted. After that, MEBO Wound & Ulcer Dressing is applied to cover and bandage the surgical site with the dressing-change once per day, till the wound healing.
4.6. The therapeutic key-points of MEBT/MEBO in the treatment of donor site
It has been a many years history to apply autologous skin grafting to treat various kinds of wounds. And it has gained good results. However, the intervention on the donor site seems insufficient with the existence of some deficits, such as the pain after operation, long-term healing periods and the scar formation on a full-thickness skin graft5. After the verification from the large-sample clinical trials that MEBT/MEBO has achieved great efficacy on the treatment of donor sites. The therapeutic key-points: Prepare the donor skin routinely (cleaning, disinfect and bandage with sterile dressings); for those with local aesthesia, the epinephrine should not be added into anesthetic; after removing the skin slices or stripes form the donor, the donor site is covered by MEBO Wound & Ulcer Dressing; and then add multiple layers of gauze pad to bandage with pressure. 24 hours after the procedure, change the dressing. Then, the frequency of dressing-change is once per day till the wound healing.
4.7. The therapeutic key-points of MEBT/MEBO in the treatment of anorectal surgical wounds, the wounds on ears, nose and mouth and the gynecological lesions
4.7.1. Haemorrhoids and fistula are the most common disorders in clinics. The routine dressing-change after the anorectal and hemorrhoid procedures will cause severe soreness. After applying MEBT/MEBO, pain during dressing-change is greatly relieved with precipitating healing process. The therapeutic key-points: MEBO gauze should be chosen during the dressing-change process 1 to 2 times per day.  
4.7.2. In the disorders with high rate of incidence occur on the ears, nose and mouth, the chronic atrophic rhinitis and mucosal erosion of nasal septum both often cause nasal bleeding with long-term refractory ulcer, as well as the severe pain during the dressing change after the excision of nasal polyp and turbinectomy. For the above conditions, there are no effective interventions provided in the western medicine. But with the application of MEBT/MEBO, it can realizes the rapid in situ regenerative restoration and the apparent relief of the post-operational pain during the dressing-change; the inflammation of external auditory cannel, oral ulcer, angular stomotitis, acute and chronic conjunctivitis are chronic intractable disorders, with MEBT/MEBO, the rapid in situ regenerative restoration of chronic inflammation and ulcers can be gained; in addition, the wounds after the radio frequency therapy for chronic pharyngitis, surgical sites after the oral procedures and the lesion after tooth extraction often have severely pain and takes effects on normal dietary consumption. Sometimes, the symptoms of infection, long-term healing and bleeding would occur. With MEBT/MEBO, it will either sooth the pain or prevent the wound from infection and promote the wound healing. The therapeutic key-points: topically administer MEBO Wound Ointment.
The route of administration: (1) by intracavity; (2) on the buccal area or by oral; (3) MEBO gauze plugging.
4.7.3. Cervicitis and cervical erosion: cervicitis and cervical erosion are both the most common disorders in the adult women. There are some extents of difficulties in the treatment with high recurrent rate that severely endangers the physical and psychological health on female. According to many study reports, after being treated by MEBT/MEBO, it will not only rapidly in situ restore the ulcer, but also leaves no scarring. After laser therapy and cryotherapy on the patient with cervical erosion in association with MEBT/MEBO, client has no fall feeling of lower abdominal and no watery secretion.
The therapeutic key-points:
(1) MEBO cotton ball or piece: place the client on the lithotomy position. Insert endoscope, gently wipe the cervical wound. Send the MEBO cotton ball or piece with long forceps or long hemostatic forceps. 2 to 4 grams MEBO absorbed into the cotton ball or piece for each time are better. Change the dressing 1 to 2 times per day.
(2) Vaginal douche: directly squeeze MEBO Wound Ointment into the vagina 3 to 5 grams per time. Change the dressing 1 to 2 times per day. This method is mainly indicative for the patient with cervical erosion and having vaginitis and vaginal ulcer either.
(3) Insertion of MEBO gauze: this method is best for the patient with the combinative occurrence of vaginitis, vaginal erosion, ulcer and cervical erosion. Insert MEBO gauze or cotton ball gently loosely into the vagina and change the dressing 1 to 2 times per day.
(4) MEBT/MEBO in association with laser therapy or cryotherapy: This method is applicable for the client with cervical erosion receiving laser therapy.
(5) Vulva ulcer: vulva ulcer is complicated after the vulva inflammation. It can be concurrently seen on the patient with non-specific vulva inflammation, herpes simplex virus infection, vulva tuberculosis, syphilis, LGV (Lymphogranuloma Venereum). It commonly divided into acute and chronic ulcer. With the application of MEBT/MEBO, it has the functions of good analgesic, patency of drainage, depression of bacterial growth, promotion of healing and increased irritation and further damage on the wound.
(6) Wound formed after the laser therapy and cryotherapy for the leukoplakia vulvae can be rapidly regenerated and restored with MEBT/MEBO.
4.8. The therapeutic key-points of MEBT/MEBO in the treatment of integumentary disorders
The intergumentary wounds and ulcers caused by the invasion of microorganisms (such as bacterial, virus and fungal) and varieties of dermatitis that is the result of physical, chemical, biological, allergic, medical and immunological causes, can be treated by MEBT/MEBO with good results. The therapeutic key-points of MEBT/MEBO are the application of MEBT or MEBO Wound & Ulcer Dressing in association with the treatment of causative factors.
1Xu Rongxiang. Human Body Regenerative Restoration Science (M) First Edition, Beijing; Chinese Social Scientific Press, 2009:1
2Xu Rongxiang. Clinical Handbook of Burn Regenerative Medicine and Therapy (M) First Edition, Beijing: Taihai Press, 2006: 33~34.
3Xu ROngxiang. Human Body Regenerative Restoration Science (M) First Edition, Beijing; Chinese Social Scientific Press, 2009:29
4Xu ROngxiang. Human Body Regenerative Restoration Science (M) First Edition, Beijing; Chinese Social Scientific Press, 2009:28
5Xu Rongxiang, Zhang Xiangqing and et al. Clinical Studies about the in situ Regenerative Restoration of the Donor Site J. Chinese Journal of Burns, Wounds and Ulcers, 2006, 18 (1):1.
6Xu Rongxiang, Zhang Xiangqing and et al. Clinical Studies about the in situ Regenerative Restoration of the Donor Site J. Chinese Journal of Burns, Wounds and Ulcers, 2006, 18 (1):8.