Impact of Topical Heparin on Healing of Skin Graft Donor Site in Burn Patients

Background The ability of topical heparin application to improve the healing outcome of burn wounds has been demonstrated by several studies. However, its impact on healing of skin graft donor site was not studied. Aim The present study was done to compare the healing outcome (healing time, pain, itching, scarring and complications) of topical heparin treatment with topical conventional treatment in the donor areas after skin grafting in burn patients. Methods This prospective, interventional, controlled, single-blinded clinical study was done on 40 patients with 2nd or 3rd degree burns of any etiology and <30% of body surface area requiring skin grafting, aged 18-65 years, of both sexes. Each patient was subjected to harvesting of two grafts. Patients served as their own controls. One donor area was treated with topical heparin and the other was treated with the topical conventional treatment. Immediately after graft harvesting, all donor areas were treated conventionally. Starting from the 2nd day, each donor area was treated once daily according to its group allocation. The topical heparin donor area was treated with heparin diluted in saline in a concentration of 250 IU/ml in a dose of 4200 IU/1% total body surface area (TBSA). The area was covered with gauze soaked with the solution for 5 days. The conventional treatment (control) donor area was covered by gauze soaked with an equivalent amount of normal saline on top of Vaseline gauze. Heparin was to be discontinued if the platelet count before each session was < 100,000 /mm3 and/or APTT exceeded double the reference value. Pain was assessed twice daily for 5 days. The patients’ donor areas were followed-up postoperatively for 8 weeks for healing time in days, itching over the wound and scarring using Vancouver Scar Scale. Complications in the form of wound site bleeding or infection were recorded. An analgesic was given twice daily for 5 days then as needed. Results There were no statistically significant differences between the two donor areas regarding the site and size. The healing time was significantly shorter in the heparin donor areas (P < 0.00001) with less scarring reported as significantly lower scores of the Vancouver scar scale compared with the control donor areas for each component and the total score (P < 0.05). Pain, itching and infection rate were insignificantly less in the heparin area. Bleeding was not observed in any of the areas in all cases and the daily values of platelet count and APTT in the five treatment days did not differ significantly compared with the preoperative values. None of the patients showed a platelet count < 100,000 /mm3 or APTT exceeding double the reference value. Conclusion Topical heparin treatment, compared with topical conventional treatment, of the donor areas after skin grafting in burn patients resulted in better clinical outcome manifested as significantly shorter wound healing time and significantly less scarring with no treatment-related complications.

Comparative Study between Topical Heparin and Nebulised Heparin in the Management of Thermal Burn Patients in a Tertiary Care Hospital, Tirupati

BACKGROUND Burn treatment is complex and involves many components. Topical solutions that contain antiseptic, antibiotic, and growth factor properties are effectively used in superficial burns. Heparin satisfies all the parameters. Routes of heparin administration described are subcutaneous, topical, intravenous, and inhalation. In this study, the need was felt to evaluate the efficacy of various heparin routes such as topical against nebulised heparin. METHODS 100 consecutive thermal burn patients were studied prospectively under two groups i.e., topical heparin (T group) and nebulised heparin (N group). Hospital stay, final scar outcome, wound infection rate, secondary procedures, pain medication, dressings and antibiotics required were compared. RESULTS It was found that the T patients complained of less pain and received less pain medication, fewer dressings and antibiotics compared to N group. Significantly less IV fluids were infused to T group 36 vs 64 litres compared to N group (P < 0.01). T group had fewer secondary procedures 6 vs 14 compared to N group. The number of days in hospital for T was significantly less (over all P < 0.0001). 14 patients (28 %) in the topical group were discharged from the hospital in 10 days or less compared with 8 patients (16 %) in the nebulised group (P < 0.001, S). 38 out of the 50 H patients (76 %) were discharged in less than 3 weeks compared with 22 nebulised group patients (32 %) (P < 0.001, S). CONCLUSIONS Usage of Heparin is safe, needs no monitoring by bleeding time (BT), clotting time (CT), or partial thromboplastin time (PTT). The final scar outcome with parameters such as scar itchiness, texture, the wound infection rate, secondary procedures like a skin graft, post-burn contractures release were fewer in burn patients treated with topical heparin. KEYWORDS Topical Heparin, Nebulised Heparin, Hospital Stay, Scar Outcome, Secondary Procedures, Pain

Role of Topical Heparin in Treatment of Burn at Tertiary Care Hospital in Western Rajasthan

Background: Heparin is a multifaceted compound with uses not only as an anticoagulant, but also as an anti-inflammatory, anti-allergenic, anti-histaminic, anti-serotonin, anti-proteolytic and neoangiogenic agent. The aim of the study was to study the effect of topical heparin in the management of burns in terms of morbidity, mortality & safety. Subjects and Methods: A hospital based RCT with total duration of 16 months from June, 2018 to September, 2019 with 100 patients (age between 15-45 years, burns from 20-60%, with less than 48 hours duration), randomly enrolled into 2 groups, after initial resuscitative measures, 50 cases receiving Topical Heparin treatment, 50 controls receiving conventional treatment (1% silver sulphadiazine) with i.v. antibiotics, after explaining the study objectives and taking informed written consent. Data analysis was performed using Epi Info software. Results: Patients treated with topical heparin experienced statistically significant (p<0.05) improved pain relief, rapid healing, lesser complications and reduced duration of hospital stays. Conclusion: The current study demonstrates that topical heparin can improve clinical outcomes in the treatment of burn injury.