Mohamed, N., Abolnaga, A., Moghazy, A., Gomaa, A. (2024). Comparison between Topical Beta-Sitosterol and Topical Hirudin in Management of Facial Burns. The Egyptian Journal of Plastic and Reconstructive Surgery, 48(1), 7-15. doi: 10.21608/ejprs.2024.336304
Nourhan G E D Mohamed; Ahmed Mohamed Abolnaga; Amr Mohamed Moghazy; Amr Abdallah Gomaa. "Comparison between Topical Beta-Sitosterol and Topical Hirudin in Management of Facial Burns". The Egyptian Journal of Plastic and Reconstructive Surgery, 48, 1, 2024, 7-15. doi: 10.21608/ejprs.2024.336304
Mohamed, N., Abolnaga, A., Moghazy, A., Gomaa, A. (2024). 'Comparison between Topical Beta-Sitosterol and Topical Hirudin in Management of Facial Burns', The Egyptian Journal of Plastic and Reconstructive Surgery, 48(1), pp. 7-15. doi: 10.21608/ejprs.2024.336304
Mohamed, N., Abolnaga, A., Moghazy, A., Gomaa, A. Comparison between Topical Beta-Sitosterol and Topical Hirudin in Management of Facial Burns. The Egyptian Journal of Plastic and Reconstructive Surgery, 2024; 48(1): 7-15. doi: 10.21608/ejprs.2024.336304
Comparison between Topical Beta-Sitosterol and Topical Hirudin in Management of Facial Burns
The Department of Plastic Surgery, Faculty of Medicine, Suez Canal University
Abstract
Background: Facial burns are challenging, as the aesthetic outcome is as important as the functional. Topical interventions are currently the cornerstone of treatment of facial burns. Although there is no gold standard agent for the treatment of facial burns, beta-sitosterol is the most commonly used as first line agent. Recombinant hirudin is an agent derived from medicinal leech and it has anti-thrombotic action, which is thought to have effect on facial burns healing. Objective: The objective of this study is to compare the effect of beta-sitosterol and hirudin in the management of facial burns regarding the pain, edema, healing time, and aesthetic outcome. Patients and Methods: A concurrent self-control open label clinical trial was conducted on fifteen patients attending the burn unit at Suez Canal University Hospital with facial burns. Visual Analogue Scale for pain to time, edema, hospitalization time, healing time, scarring by the patient and observer scar assessment scale (POSAS) and final aesthetic outcome. Expected Outcome: In patients with facial burns, the use of topical hirudin will reduce pain and edema; enhance faster healing and less hospitalization time, less scarring and better final aesthetic outcome. Conclusion: Topical hirudin use in facial burns is a safe and effective option as it showed statistically significant results regarding wound healing and final scar quality outcome that was better than topical beta-sitosterols. Although its effects regarding pain and edema showed no statically significant difference in comparison to topical beta-sitosterols, it should be considered as an effective safe option in the treatment of facial burns.
Ang E.S., Lee S.T., Gan C.S., et al.: The role of alternative therapy in the management of partial thickness burns of the face-experience with the use of moist exposed burn ointment (MEBO) compared with silver sulphadiazine. Ann. Acad. Med. Singap, 29 (1): 7-10, 2000. 2- Azizkhan R.G., Azizkhan J.C., Zetter B.R. and Folkman J.: Mast cell heparin stimulates migration of capillary endothelial cells in vitro. J. Exp. Med., 152 (4): 931-944, 1980. 3- Buderer N.M.: Statistical methodology: I. Incorporating the prevalence of disease into the sample size calculation for sensitivity and specificity. Acad. Emerg. Med., 3 (9): 895-900, 1996. 4- Chae J.K., Kim J.H., Kim E.J. and Park K.: Values of a Patient and Observer Scar Assessment Scale to Evaluate the Facial Skin Graft Scar. Ann. Dermatol., 28 (5): 615-623, 2016. 5- Clark C., Ledrick D. and Moore A.: Facial Burns. In: Stat- Pearls. Treasure Island (FL): StatPearls Publishing, July 8, 2021. 6- Demling R.H. and Pomposelli J.J.: In: Surgical Infections. Meakins J.L., editor. New York: Scientific American Medicine, 369-373, 1994. 7- Demling R.H., Wong C., Jin L.J., Hechtman H., Lalonde C. and West K.: Early lung dysfunction after major burns: Role of edema and vasoactive mediators. J. Trauma, 25 (10): 959-966, 1985. 8- El-Hadidy M.R., El-Hadidy A.R., Bhaa A., Asker S.A. and Mazroa S.A.: Role of epidermal stem cells in repair of partial-thickness burn injury after using Moist Exposed Burn Ointment (MEBO(®)) histological and immunohistochemical study. Tissue Cell, 46 (2): 144-151, 2014. 9- Fawzy Ahmed Hamza, Ahmed Abu-Elsoud Salim and Hossam Nasr Rizk: “Evaluation of the Effect of Topical Heparin on the Treatment of Facial Burn”. Al-Azhar International Medical Journal, 1 (2): 198-202, 2020. 10- Gojowy D., Kauke M., Ohmann T., Homann H.H. and Mannil L.: Early and late-recorded predictors of health-related quality of life of burn patients on long-term follow- up. Burns, 45 (6): 1300-1310, 2019. 11- Griffin J.E. and Johnson D.L.: Management of the maxillofacial burn patient: Current therapy. J. Oral Maxillofacial Surg., 63 (2): 247-252, 2005. 12- Gupta A., Gupta P. and Verghese T.: Role of topical heparin in the management of burns. Experience in a district government hospital of Karnataka in South India, 2 (3): 111-112, 2015. 13- Hoogewerf C.J., Hop M.J., Nieuwenhuis M.K., Oen I.M., Middelkoop E. and Van Baar M.E.: Topical treatment for facial burns. Cochrane Database Syst. Rev., 7 (7): CD008058, 2020. Published 2020 Jul 29. 14- ISBI Practice Guidelines Committee: Steering Subcommittee; Advisory Subcommittee. ISBI Practice Guidelines for Burn Care. Burns, 42 (5): 953-1021, 2016. 15- ISBI Practice Guidelines Committee: Advisory Subcommittee; Steering Subcommittee. ISBI Practice Guidelines for Burn Care, Part 2. Burns, 44 (7): 1617-1706, 2018. 16- Draaijers L.J., Tempelman F.R., Botman Y.A., Tuinebreijer W.E., Middelkoop E., Kreis R.W., et al.: The patient and observer scar assessment scale: A reliable and feasible for scar evaluation. Plast Reconstr Surg., 113 (7): 1960- 1967, 2004. 17- Maciag T., Mehlman T., Friesel R. and Schreiber A.B.: Heparin binds endothelial cell growth factor, the principal endothelial cell mitogen in bovine brain. Science, 225 (4665): 932-935, 1984. 18- Manzoor S., Khan F.A., Muhammad S., et al.: Comparative study of conventional and topical heparin treatment in second degree burn patients for burn analgesia and wound healing. Burns, 45 (2): 379-386, 2019. 19- Markwardt F.: The development of hirudin as an antithrombotic drug. Thromb. Res., 74: 1-23, 1994. 20- Masoud M., Wani A.H. and Darzi M.A.: Topical heparin versus conventional treatment in acute burns: A comparative study. Indian J. Burns, 22: 43-50, 2014. 21- Mertens D.M., Jenkins M.E. and Warden G.D.: Outpatient burn management. Nurs. Clin. North. Am., 32 (2): 343- 364, 1997. 22- Moher D., Schulz K.F. and Altman D.G.: The CONSORT Statement. Revised recommendations for improving the quality of reports of parallel-group randomized trials. Lancet, 357 (9263): 1191-1194, 2001. 23- Nowak G.: Pharmacology of recombinant hirudin. Semin. Thromb. Hemost., 28: 415-423, 2002. 24- Palmieri T.L., Przkora R., Meyer W.J. and Carrougher G.J.: Measuring burn injury outcomes. Surg. Clin. North. Am.,94 (4): 909-916, 2014. 25- Saliba M.J. Jr., Dempsey W.C. and Kruggel J.L.: Large burns in humans. Treatment with heparin. JAMA, 225 (3): 261-269, 1973. 26- Saliba Jr., M.J.: “Heparin In Burns Protocol.” Internet website: http://www. salibaburnsinstitute. org and ProEgypt, J. Plast. Reconstr. Surg., January 2024 15 ceedings, Heparin Effects In Burns International Symposium, 2000. 27- Saliba M.J. Jr. and Saliba R.J.: Heparin in burns. Dose related and dose dependent effects. Thromb Diath Haemorrh., 33 (1): 113-123, 1975. 28- Teles G.G. do A. and Bastos J.A.: Treatment of superficial Second- degree burn of face and neck with topical heparin. A comparative, prospective and randomized study. Revista Brasileira de Cirurgia Plástica. SciELO Brasil, 27: 383- 386, 2012. 29- Venkatachalapathy T.S.: A comparative Study of Pediatric Thermal Burns Treated with Topical Heparin and Without Heparin. Indian Journal of Surgery, 76 (4): 282-287, 2014. 30- Venakatachalapathy T.S., Mohan Kumar S. and Saliba M.J.: A comparative study of burns treated with topical heparin and without heparin. Annals of Burns and Fire Disasters, 20 (4): 189-198, 2007. 31- von Arx T., Tamura K., Yukiya O. and Lozanoff S.: The Face. A Vascular Perspective. A literature review. Swiss Dent J., 128 (5): 382-392,