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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
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