Adjunctive Moist Exposed Burn Ointment for Complex Chronic Wounds: A Case Series Highlighting Clinical Improvement and Potential Tissue-Remodeling Mechanisms

Introduction: Chronic and complex wounds frequently remain arrested in a prolonged inflammatory state characterized by oxidative stress, impaired angiogenesis, fibroblast dysfunction, and dysregulated extracellular matrix remodeling. Moist Exposed Burn Ointment (MEBO) is an oil-based topical formulation that may support wound healing by maintaining a moist wound environment and providing bioactive constituents with anti-inflammatory, antioxidant, antimicrobial, angiogenic, and epithelialization-promoting properties. This case series describes the clinical progression of three complex wounds treated with MEBO as an adjunct to individualized wound management. Case Illustration: Three adult patients presented with diabetic hand infection with tissue necrosis, Wagner grade IV diabetic foot ulcer complicated by osteomyelitis and necrotizing fasciitis, and a traumatic degloving wound. All patients underwent sharp debridement and received pharmacological therapy according to their clinical conditions. The third patient additionally received negative-pressure wound therapy and platelet-rich plasma. MEBO was incorporated into the dressing regimen every three to four days. At the last available follow-up on days 53, 56, and 60, wound area decreased from 35 to 15 cm², 105 to 40 cm², and 120 to 30 cm², corresponding to reductions of 57.1%, 61.9%, and 62.5%, respectively. Perdanakusuma scores improved from 13 to 5, 10 to 7, and 11 to 4. Serial TIME assessments demonstrated reduced exudate, resolution of infection-related findings in the infected wounds, and healthier granulation tissue and wound edges. Discussion: The observed clinical changes are consistent with the proposed ability of MEBO to maintain moisture, protect cellular viability, facilitate gentle debridement, and support angiogenesis, fibroblast activity, collagen deposition, re-epithelialization, and tissue remodeling. However, the independent contribution of MEBO cannot be separated from concurrent wound-care interventions. Conclusion: Adjunctive MEBO use was associated with consistent improvement in wound area and clinical wound parameters across three heterogeneous complex wounds. Prospective controlled studies using standardized treatment protocols and objective remodeling biomarkers are required to clarify its therapeutic contribution.