Eighteen cases of soft tissue crush injury were reported. 

Early incision and drainage was performed and then MEBO gauze dressing was used. 

The necrotic tissues were liquefied and removed as early as possible and the dead-alive tissues recovered as early as possible. 

The newly born granulation tissues grew out. 

The dead-alive tissues were maximally preserved.

The amount of physical disability was decreased obviously.

For wound with relatively large area of defect, auto skin grafting or skin flap transposition was performed to repair the wound and it recovered well.

Treatment Method
No obvious heart and kidney injury happened according to the physical examination after the patient entered the hospital. 

The wound was debrided at different anaesthetic conditions. The dry and necrotic tissues were removed after conventional rinsing. The crushed tissue with moderate elasticcity was preserved. Radial incision was applied to the skin of the wound. 

And the distance of the incision region should be about 2 cm. Blunt dissection was performed to separate the shallow and deep fascia until normal tissues were reached at the proximal end and bleeding occurred. Peroxide and saline was used to rinse the wound. 

Sterile gauze with adequate MEBO used as the drainage strip was intruded into the isolation clearance gently. Sterile gauze was used externally to bandage the wound decompressively. 

The wound dressing was changed 1~2 times a day.

The fracture was fixed with small splint. For patients with bone exposure or muscle tendon injury, MEBO gauze was used to cover the wound and special treatment was not performed temporarily. 

Auto skin grafting was performed to cover the whole wound after the necrotic tissues dropped and the granulation grew over the exposed tissues. For patients with muscle tendon rupture or defect, different operations were performed in combination with functional exercise according to different conditions half-year after the wound recovered thoroughly.

Discussion

Early incision and drainage in combination with MEBO gauze was adopted to treat soft tissue crush wounds and the curative effect was satisfactory.

The injured tissues were necrotic after the tissues were crushed and the blood carry decreased sharply or stopped. The swelling was not serious at this time and it was mainly caused by ischemia because the tissues were compressed. The lesion area was incised and drained. Blunt dissection was performed and the pressure suffered by the injured tissues decreased sharply because of separation and the blood circulation continued. The injured tissues obtained oxygen and other nutrients and survived. This treatment was different from those of the past. 

In the past, the injured tissues were removed thoroughly until fresh blood appeared in the wound. The tissues at the cutting edge had contractile function with bright red color. Relaxation suture was required. All the dead-alive tissues were removed then it would enlarge the defect area. The mutilation rate would increase after healing. However, the early incision and drainage would preserve the dead-alive tissues thoroughly.

After the incision and drainage, MEBO gauze was used as draining strip. MEBO has good pain killing function. It can keep the environment moist and clean when treating crush wound of the soft tissues. 

In the reaction of MEBO, the dead-alive tissues protected the injured tissues from dryness and then promoted the liquefaction and sloughing of necrotic tissues that did not have survival base. 

After the dead-alive tissues recovered, the whole tissue grew rapidly to cover the wound. 

At last, it would promote the growth of granulation tissue and other endepidermis tissues and the healing of the wound.

MEBO had anti-infection ability of leading to bacterial dissociation and relieving the toxin of the bacterial. 

The immunity of the body increased after the application of anti-bacterial medicine systematically to the patient. The operation of all kinds of shapes of skin flaps or the whole piece of auto skin transplantation according to the condition of the wound to cover the wound would become relatively easy after the crushed wounds of soft tissues became granulation wound. The granulation wound was not large any more then.

The healing time of fracture wouldn’t be longer than that of other fractures and the exposed bone and muscle tendon region wouldn’t become dry and necrotic under the protection of MEBO. Muscle tendon operation was performed half a year after the wound recovered thoroughly. The success ratio was high and the incidence rate of physical disability decreased significantly.

Method:

The requirements of MEBO gauze: 

• first, the thickness of MEBO on the gauze should be 1 mm thicker than that of direct spreading onto the wound and it must be evenly distributed on the gauze; 
• second, the wound must be kept moist and clean. It mustn’t be dry. The injury would be aggravated because of dryness if the amount of medicine on the wound decreased. Latrogenic injury to the recovered dead-alive tissues that already survived shouldn’t happen. 
• Third, the wound dressing should be changed timely The accumulation of the untimely removed exudation on the wound would not only affect the function of the medicine to the wound but also cause adverse effect on the recovery and growth of the injured tissues. The wound dressing should be changed 1~2 times a day at least. It would be better to change the wound dressing once every 6~8 hours at the crest time of liquefaction. This kind of change of wound dressing would keep the wound clean and moist and fresh all the time and the dead-alive tissues would be always in the good environment for recovery and growth. Vigorous developments were realized and the early reparation of the wound could be realized; 
• fourth, decompressed bandaging or simple covering method should be adopted. Tight bandaging that may affect the blood circulation and increase the iatrogenic injury of the injured tissues was forbidden.

This method is simple and has good curative effect. The requirements for equipments are not high so it’s easy to be popularized.

Full Report:

Soft Tissue Crush Injury after Early Incision and Drainage Treated with MEBO Gauze, The Chinese Journal of Burns, Wounds and Surface Ulcers 1998(1): 45