Study on the efficacy of Palandu Ghrita in the Management of Sutured Clean Lacerated Wound w.s.r. To Hypertrophic scar

Ayurveda is a science of life and is believed to exist as long as the origin of life on this nature as it mentioned in Charak Samhita. Ever since, the life originated, human being has been susceptible to injury which is made him to think about healing. 
Hypertrophic scar  is a type of scar characterized by hypertrophy or proliferation of mature fibroblast or fibrous tissue without proliferation of blood vessels. It is caused due to tissue formation during healing process.   Acharya Sushruta has mentioned Palandu (Allium Cepa) as Sthirdhatukarta  and Krumighna. Palandu is one of the oldest cultivated vegetables in indian history. Palandu contains vitamin A, C and proteins which are essential factors for wound healing ,with keeping  these factors in mind,present study was planned as a local application of Palandu Ghrita to prevent hypertrophic scar because prevention is better than cure. 
For this research study we designed 2 groups viz. experimental group (Group A) i.e. application of Palandu Ghrita and control group (Group B) i.e. application of plain gauze piece. In this, we observed 30 patients from each group according to age, occupation, family history, sharir prakruti etc. and made result on the basis of assessment criteria like pain, scar colour, pliability, tenderness etc. By taking all observations into consideration we made result by using Wilcoxon signed rank test and Mann Whitney’s U test and came on the conclusion that Palandu Ghrita application prevents hypertrophic scar with economical and easy acceptability. 
 


Introduction
The history of medical sciences starts with the art and skill of wound healing. Treatment of wound is probably the first medical problem faced by human beings. The frequency of injuries is more common than any other disease.
While explaining the scope of Shalya Tantra, Sushruta has mentioned Vrana as a major part of surgery. As per Svabhavoparamvaad (1) stated that healing of any pathology happens naturally. Therefore, healing of V rana is also a natural process of the body but V rana should be protected from Dosha-Dushti and from various micro-organisms, which may afflict the Vrana and affected the normal healing process. From the ancient period, after the discontinuity of skin causes the wound (2) called V rana which heals and forms Vranavastu (3) that means scar. This scar never disappear for the rest of life. A charya Sushruta has minute observation about this V ranavastu (Scar) that it looks very ugly.
Surgery is an art and suturing is a fine art. The people in the present era are too much conscious about their cosmetic look. In case of repair of external skin injury and after undergoing surgical procedure, everybody demands that there should be no scar or minimum scar formation. People are even under go cosmetic surgery to get rid of their ugly scars. Keeping this fact in view, in the field of surgical practice, lot of emphasis has been given for search of scar less preventive treatment.
Hypertrophic scar (4) is a type of scar characterized by hypertrophy or proliferation of mature fibroblast or fibrous tissue without proliferation of blood vessels. It is caused due to tissue formation during healing process. Hypertrophic scars are indurate, elevated, poorly extensible and also characterized by hypervascularity thereby providing their erythematous appearances. In modern science there are treatments (5) to cure hypertrophic scar such as topical medical applications, cryotherapy, use of silicone gel sheets, injection of steroids, radiotherapy, surgical excision, dermabrasion, pressure therapy, pulse dye and carbon dioxide laser ablations. But these techniques are unreliable, unpredictable, expensive, long hospitalization and causes chemical irritations. Due to steroid therapy skin looks reddish and thinnest which can causes rodent ulcers or basal cell carcinoma (6) commonly over face.
Acharya Sushruta has mentioned Palandu (Allium Cepa) as Sthirdhatukarta (7) and Krumighna. Palandu is one of the oldest cultivated vegetables in history. This contain a readily and highly researched bioflavonoids (8) with antihistamine and antiproliferative effects on both normal and malignant cells. These properties could theoretically prove beneficial in reversing the inflammatory and proliferative responses. Palandu contains vitamin A, C and proteins which are essential factors for wound healing (9). Palandu contains 80% of moisture which prevents Kshaya of Rasa Dhatu. It is Madhur Rasatmak Dravya (10) which helps in Sandhan Karma of Vrana. we were taking this study as a local application of Palandu Ghrita to prevent hypertrophic scar because prevention is better than cure.

Aims and Objectives Aim
To study the efficacy of Palandu Ghrita in the management of sutured clean lacerated wound to prevent hypertrophic scar.

Objectives
To study properties of Palandu Ghrita like Krumighna, Sthirdhatukarta, Sukharopaniya.  How to use  It is for external use only.  Clean affected area.  Apply small amount topically to affected area 1-3 times daily.  May cover with sterile bandage.

Mechanism of action
When applied locally it produces nascent oxygen which creates plane of cleavage between lining tissue and slough and removal of slough mechanically due to release of catalase.
It produces effervescence on application which removes the bacteria. Its foaming action wash outs the bacteria. It has short duration of action and mechanically causes removal of tissue debris. It creates heat when applied locally, causing coagulation of proteins and also provides hemostasis.

Group B
Treated with Plane gauze piece application comprised of 32 patients. Among them 02 patients left the treatment against medical advice.

Table No. 3: Observation of 60 patients according to Age
It was found that maximum number of patents i.e. 36.66% belonged to age group of 31 -40 years,15% patient belonged to 21 -30 , 41-50, 51-60 years of age group each, while 11.66% patients belonged to 16 -20 years and 06.66% of patients belonged to 61 -70 years of age group.

Table no. 4: Observation 0f 60 patients according to Built
The table has shown that out of 60 patients studied, the maximum numbers of patients i.e. 58.33% have observed were obese whereas 28.33% were had normal built and 13.33% were underweight.

Graph no. 2: Overall effect of therapy on clinical features in Group A
In group A, % of relief was obtained among 30 patients of sutured clean lacerated wound -relief in pain was 85.21%, relief in tenderness was 75.75%, relief in discharge was 80%, relief in inflammation was 80.32%, relief in pliability i.e. elasticity of scar was 74.77%, relief in consistency of scar was 88.57%, relief in scar height was 86.53%, relief in scar color was 71.42%, relief in extension of scar was 96.66%.

Graph No. 3: Overall effect of therapy on clinical features in Group B
Probable mode of action Among the ingredients of Palandu Ghrita drugs are having Madhur Rasa, Guru, Snigdha Guna and Sheeta Veerya, so these drugs are very effective to break the pathogenesis of Sadyovrana w.s.r. to hypertrophic scar as well by Virtue of these properties Palandu Ghrita simultaneously acts as a Shodhan and Ropana.
Acharya Sushruta has mentioned Palandu (Allium Cepa) as Sthirdhatukarta and Krumighna. Palandu contains 80% of water which prevents Kshaya of Rasa Dhatu and also dryness of wound on other hand it provides moisture to wound. It is Madhur Rasatmak Dravya which helps in Sandhan Karma of Vrana.
Action on the basis of V eerya: Due to Sheeta Veerya of ghrita it has properties of Ropan, mrudukarma. It plays important role to soften the wound due to sheeta virya.
As per morphology, Palandu is made up of very thin layers just like human skin. So according to Samanya Vishesh sidhant (84] we conclude that each layer of Palandu acts on each layer (7 layers) of human skin for wound healing.
This contain a readily and highly researched bioflavonoids with antihistamine and antiproliferative effects on both normal and malignant cells. These properties could theoretically prove beneficial in reversing the inflammatory and proliferative responses. Palandu contains vitamin A, C and proteins which are essential factors for wound healing.
At the time of presentation, the patient had pain, discharge, tenderness etc., with predominating V ata Dosha. After application of Palandu ghrita, Madhura Rasa of the Palandu as well as Goghrita reduced the vitiated V ata Dosha, leading to reduced pain and enhanced healing.
Onion bulb mainly contains 1.2% protein, 11.6% carbohydrate, calcium, iron, vitamin A, B and C. Onion bulb contain a good number of phytochemicals most of which are hydrocarbons and their derivatives. These includes-Dipropyl disulphide (which is used as flavor compound), Allicin (which has antidiabetic, antibiotic and antithrombotic properties.), Diathyl sulphide (which has insecticidal property).
Onion cgontain Sulphur compounds which acts as anti-inflammatory.
Goghrita also contains Vitamin A, D, E and K. Vitamins A and E are anti-oxidant and are helpful in preventing oxidative injury to the body.

Conclusion
Depending on the observations obtained and detailed discussion on this observation, following conclusion can be drawn.
Hypertrophic scar formation is commonly seen in obese female who has Rasakshayata and of V ata-pitta prakruti.
To prevent hypertrophic scar is an important factor for the healing of wound. Hypertrophic scar control was obtained in patients by external application of Palandu ghrita.
Palandu contains 80% of moisture which prevents rasa dhatu kshya; the dhatu mainly important in wound healing.
Palandu acts as anti-microbial, antiinflammatory, anti-proliferative and anti-fungal agent hence helps in early wound healing & early healing prevents scar formation.
Palandu ghrita has shown Krumighna, Sukharopaniya, Sthirdhatukarta and Varnya properties in the management of Sadyovrana and prevents hypertrophic scar.
Palandu is madhur rasatmak which helps in sandhan karma of vrana.
Method of application is easy, simple and cost effective.
As per morphology, Palandu is made up of very thin layers just like human skin. So according to Samanya Vishesh sidhant we conclude that each layer of Palandu acts on each layer (7 layers) of human skin for wound healing.