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The revascularization of ischemic tissue was the key many of these are uncontrolled and inadequately define
feature preventing extension of burns and hence a the appropriate treatment and outcomes. Further research
better outcome in patients treated with heparin. These is needed to assess the clinical utility of using heparin in
improvements were presumed to be a function of the treatment of burn injuries. [15]
heparin’s neoangiogenic effects. [5-7]
Prior studies have suggested that orally administered REFERRENCES
antibiotics can reach burns secondary to an
increase in blood flow mediated by the enhanced 1. Teot L, Otman S, Brancati A, Mittermayr R. Burn scar treatment. In:
Kamolz LP, Jescheke MG, Horch RE, Küntscher M, Brychta P, editors.
neoangiogenic-revascularization of the ischemic tissue. [8-10] Handbook of Burns. Vienna: Springer; 2012. p. 55‑67.
A reduction in intestinal bacterial translocation and sepsis 2. Masoud M, Wani AH, Darzi MA. Topical heparin versus conventional
found in another study may be another partial explanation treatment in acute burns: a comparative study. Indian J Burns 2014;22:43‑50.
for the reduction of infection seen in the current study. [11] 3. Alrich EM. The effect of heparin on the circulating blood plasma and proteins
in experimental burns. Surgery 1949;25:676‑80.
The safety of large doses of topical heparin was 4. Lu J, Xu T, Yang M, Xu XW, Wu B. Heparin for the treatment of burns
demonstrated by laboratory determinations of blood 5. (Protocol). Cochrane Database Syst Rev 2011;12:CD009483.
Reyes A, Astiazaran JA, Chavez CC, Jaramillo F, Saliba MJ. Burns treated
clotting times, which were not altered. No bleeding with and without heparin: controlled use in a thermal disaster. Ann Burns
problems or other serious complications occurred. [12] Fire Disasters 2001;14:183‑91.
6. Saliba MJ Jr, editor. The Effects of Heparian in the Treatment of Burns.
There were fewer skin grafting procedures required in Proceedings of International Meeting; 1994 Feb 24‑27; San Diego, CA, USA.
Group H as compared to Group C, but this finding was 7. Saliba MJ Jr. Heparin in the treatment of burns. JAMA 1967;200:650.
not statistically significant. Mortality rates in Group H 8. Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections.
were lower than in Group C, with all of the deaths in 9. Clin Microbiol Rev 2006;19:403‑34.
Saliba MJ Jr. Heparin efficacy in burns. II. Human thermal burn treatment with
the latter group occurring in 45-60% BSA injuries. Notably, large doses of topical and parenteral heparin. Aerosp Med 1970;41:1302‑6.
there were more suicide patients in Group C (16.7%) as 10. Saliba MJ Jr, Dempsey WC, Kruggel JL. Large burns in humans. Treatment
compared to Group H (3.3%), and suicide burns tend with heparin. JAMA 1973;225:261‑9.
to be more severe. Early tangential excision and skin 11. Ferreira Chacon JM, Mello de Andrea ML, Blanes L, Ferreira LM. Effects of
grafting are not practiced at our institute due to issues of topical application of 10,000 IU heparin on patients with perineal dermatitis
and second‑degree burns treated in a public pediatric hospital. J Tissue
nonavailability of blood products and lack of consent for Viability 2010;19:150‑8.
surgery. Additional variables contributing to a prolonged 12. Elsayed E, Becker RC. The impact of heparin compounds on cellular
hospital stay include the availability of free treatment in inflammatory responses: a construct for future investigation and
pharmaceutical development. J Thromb Thrombolysis 2003;15:11‑8.
a government-aided hospital in conjunction with poor 13. Saliba MJ Jr. The effects and uses of heparin in the care of burns that improves
familial support. treatment and enhances the quality of life. Acta Chir Plast 1997;39:13‑6.
14. Venakatachalapathy TS, Mohan Kumar S, Saliba MJ. A comparative study
In 1967, Dr. Saliba MJ Jr, originally published a report of burns treated with topical heparin and without heparin. Ann Burns Fire
of the beneficial effects of intravenous heparin in large Disasters 2007;20:189‑98.
doses as a topical spray used to treat extensive burns 15. Agbenorku P, Fugar S, Akpaloo J, Hoyte‑Williams PE, Alhassan Z, Agyei F.
in 28 patients. Another study conducted in 2007 Management of severe burn injuries with topical heparin: the first
[13]
showed the utility of the use of topical heparin in treating evidence‑based study in Ghana. Int J Burns Trauma 2013;3:30‑6.
100 patients with thermal injuries. Since that time,
[14]
numerous studies have confirmed these results. [15]
How to cite this article: Gupta A, Verghese TJ, Gupta P, Gupta AK.
In conclusion, even as research for newer modalities in Role of topical heparin in the management of burns: experience in a
burn wound management continues, the authors find that district government hospital of Karnataka in South India. Plast Aesthet
some traditional modalities still have clinical relevance. Res 2015;2:111-4.
Although there are numerous studies supporting the use Source of Support: Nil, Conflict of Interest: None declared.
of heparin in the treatment of burn wound management, Received: 13-07-2014; Accepted: 29-03-2015
114 Plast Aesthet Res || Vol 2 || Issue 3 || May 15, 2015