Effect and Mechanism of Dragon's Blood on Wound Healing of Patients with Stress Hand Injury

This study aimed to explore the effect and mechanism of Dragon's Blood on wound healing in patients with a pressure hand injury. A total of 120 patients with pressure hand injury treated in our hospital were randomly divided into two groups. Sixty patients in the control group were dressed with sterile gauze, and 60 patients in the observation group were smeared with blood exhaustion. The clinical effects and serological indexes of the two groups were compared, and the mechanism of wound healing was analyzed. The results showed that the treatment effective rate of the control group was 80% and that of the observation group was 93.33%. The treatment effective rate of the observation group was dramatically higher (P < 0.05). The number of patients with good granulation tissue in the observation group was 53, which was dramatically greater than that in the control group. The number of patients with a small amount of wound exudation was 51, which was dramatically greater than that in the control group (P < 0.05). After treatment, the levels of matrix metalloproteinase (MMP-3), vascular endothelial growth factor (VEGF), and transforming growth factor B1 (TGF-B1) in the observation group increased more dramatically (P < 0.05). The level of tissue inhibitor of metalloproteinase-1 (TIMP-1) decreased to 617.23 ng/L in the observation group, and the degree of reduction was more obvious (P < 0.05). Notably, Dragon's Blood promoted wound healing at the injury site by increasing the levels of MMP-3, VEGF, and TGF-B1and decreasing TIMP-1. The area of wound reduction in the observation group was 0.27 cm2, and the reduction was more obvious (P < 0.05). The healing time of pressure hand injury in the observation group was 15.27 days, which was dramatically shorter (P < 0.05). In summary, Dragon's Blood had a good effect on the healing of the injured site in patients with pressure hand injury, which is worthy of promotion.


Introduction
Hands are the main organs of labor and work, and most work crush injuries occur in both hands or arms [1,2]. Hand injury will seriously afect people's daily life and social work, bringing physical pain and economic burden to patients [3,4]. Te pressure injury of the hand has a great impact on the hand, and it takes a long time to recover the wound, which is prone to form chronic refractory wounds so that the wound cannot be properly repaired. Te recovery is not timely, and it is difcult to achieve a normal functional state. Te infammatory reaction persists and does not heal, which seriously bothers patients [5][6][7]. If the wound treatment of pressure injury is not timely, it can easily become a chronic refractory wound, which seriously afects wound recovery [8,9].
Te formation mechanism of chronic refractory wounds is complex, and infammatory reactions and enzymes afect the recovery of wounds [10]. On the one hand, the persistence of a state of excessive infammatory response can cause the wound to continue to heal. Granulation tissue is difcult to form for a long time, and the self-repair function of the body is afected, which means it cannot meet the conditions needed for wound recovery. On the other hand, stress wounds are prone to ischemia and hypoxia, and matrix metalloproteinases are constantly activated, which will cause the decomposition of cell growth factors and afect the growth and proliferation of epidermal cells, making wound recovery difcult [11]. Western medicine usually adopts debridement treatment, surgical intervention, electrical stimulation, biotechnology, and negative pressure wound therapy to carry out wound recovery treatment [12]. Western medicine treatment causes great damage to the body, with higher costs and more side efects. Compared with Western medicine, traditional Chinese medicine treatment has less damage, fewer side efects, and signifcant efects and has been widely recognized by patients [13]. Dragon's Blood (DB) is a traditional Chinese medicine (TCM) herb used to treat pressure wounds that can promote blood circulation and dispersing stasis, generate muscle, and collect ulcers and has a good therapeutic efect on all stages of pressure ulcers [14]. DB can promote blood circulation at the wound site, improve immune cells, promote the formation of fbroblasts by promoting the expression of VEGF, and improve the epidermal repair ability near the wound. Wound repair involves the infammatory response, tissue repair, scar formation, and other processes, and a variety of cytokines are involved in wound repair and can promote wound repair. Wet application of DB on pressure wounds can reduce the probability of infection, promote the growth of granulation tissue, clean the wound, achieve decomposition and muscle building, and promote wound recovery [15].
In this study, the efect of Dragon's Blood on wound healing in patients with pressure hand injury was discussed. Te innovation of this study was that it explored the mechanism of wound recovery of pressure hand injury treated with sterile gauze and Dragon's Blood based on the serological indicators of the two groups of patients. Tis study aimed to provide clinical guidance for wound recovery treatment in patients with a pressure hand injury and to provide data support for theoretical research on wound healing in patients with a pressure hand injury.

Te Research
Object. Te subjects of this study were 120 patients with pressure hand injuries treated in our hospital from September 2020 to January 2022. Tey were divided into two groups by the random number method, including 60 patients in the control group, whose wounds were dressed with sterile gauze. Te male-to-female ratio of the control group was 34/26, with an average age of 31.33 ± 6.75 years, and the length of education was 12.33 ± 2.65 years. Tere were 60 patients in the observation group. Te wounds were smeared with Dragon's Blood, and the male-to-female ratio of the subjects in the observation group was 33/27. Te average age was 31.46 ± 6.76 years. Te length of education was 12.54 ± 2.63 years, and there was no signifcant diference in general information between the two groups (P < 0.05). Te therapeutic efect and wound recovery were compared among the subjects included in the study. Tis study was approved by the Ethics Committee of our hospital.
Inclusion criteria: (i) patient who had complete inpatient treatment data; (ii) patients over 18 years old; (iii) patient's hand sufered from pressure injury; (iv) patient who had no hereditary diseases; (v) patient who had no immune disease; (vi) patient who had no communication disorder; (vii) patients and their family members signed informed consent.
Exclusion criteria: (i) patients' medical records and follow-up data were not complete; (ii) patients with vital organ diseases; (iii) patients with other nonpressure hand injuries; (iv) patients who had coagulation dysfunction; (v) pregnant or lactating women; (vi) patients who had an inherited disease; (vii) patients who were allergic to Dragon's Blood; (viii) patients who were unwilling to participate in this study.

Methods of Dressing Treatments.
All patients in the control group received routine anti-infection treatment after debridement. From the frst day after debridement, sterile gauze (Shanghai Bejin Yangheng Products Co., LTD.) was changed every morning and evening. Sodium chloride (0.9%) cotton balls were used to clean the wound, and iodophor cotton balls were used to disinfect the wound after debridement. After disinfection, the wound was covered and bandaged with sterile gauze and fxed with adhesive tape for 30 min each time twice a day.
In the observation group, debridement was performed on the frst day after surgery. Dragon's Blood dressing was changed every morning and evening. A 0.9% sodium chloride cotton ball was used to clean the wound after the debridement operation, and an iodophor cotton ball was used to disinfect the wound. After disinfection, the wound was exposed, and a Dragon's Blood capsule (Yunnan Yunhe Pharmaceutical Co., LTD., Sinopharm approval number Z53020999, 0.3 g/capsule) was opened and evenly spread on sterile yarn. Sterile gauze was laid fat on the wound surface after debridement. Te wound was covered with sterile gauze and fxed with adhesive tape for 30 min each time, twice a day.

Observation Indicators.
General data, including sex, age, and years of education, of patients in diferent groups, were compared.
Te clinical efcacy was compared, including cure, remarkable efect, efective, and invalid. Cure referred to that all local symptoms disappeared, a remarkable efect referred to that the local symptoms were dramatically alleviated, an efective referred to that the local symptoms were reduced, and an invalid referred to that the local symptoms showed no obvious change or symptom aggravation. Te treatment efective rate (ER) was calculated. Te ER was calculated as shown in (1), where Recovery refers to the number of cured patients, Remarkable efect refers to the number of remarkable efects, Efective refers to the number of efective patients, and Total refers to the total number of patients.
Te wound recovery of the two groups was compared, mainly including granulation tissue, wound exudation amount, and wound edema. Te granulation tissue conditions included good granulation, fresh granulation, and dull granulation. It was graded as a small amount of wound seepage without permeating one gauze, a medium amount of permeating one gauze, or a large amount of permeating two or more gauze. Wound edema included no edema, degree of edema<1 cm, and degree of edema >1 cm.
Te serological indexes of the two groups were compared, mainly including MMP-3, T1MP-1, VEGF, and TGF-B1. Five milliliters of fasting peripheral venous blood were collected from the patient and centrifuged in a Danish Labogene desktop mini centrifuge. Te centrifugation time and speed were set to 15 min and 5,000 R per minute, respectively. Ten, the supernatant after centrifugation was collected for detection of serum levels of MMP-3, T1MP-1, VEGF, and TGF-B1. Te detection of the above categories of indicators was carried out by several senior inspectors in strict accordance with the relevant instructions, and the enzyme-linked immunosorbent assay was adopted to detect the serological indicators. Ten, the serum levels of MMP-3, T1MP-1, VEGF, and TGF-B1 were statistically compared between the two groups. Te wound area and wound healing time of patients were compared.

Method of Statistics.
Excel 2016 was used to record and summarize the data. SPSS 20.0 was used for data statistics and analysis. Te mean ± standard deviation (X ± S) represents the measurement data, and a t-test was used. Percentage (%) is the representation of count data using the chisquare test. P < 0.05 was considered statistically signifcant. Table 1 shows the comparison of general data between the two groups. Te mean systolic blood pressure of the control group was 123.24 ± 12.79 mmHg, and the mean systolic blood pressure of the observation group was 124.66 ± 12.38 mmHg. Te diastolic blood pressure of the control group was 82.33 ± 7.79 mmHg and that of the observation group was 81.46 ± 7.56 mmHg. Te blood glucose of the control group was 4.33 ± 1.69 mmol/L and that of the observation group was 4.54 ± 1.65 mmol/L. General information was not signifcantly diferent between the two groups (P > 0.05) and was comparable. Figure 1 shows the staging of pressure injury. Tere are six stages of pressure injury. Te frst stage was stress injury, mainly manifested as skin redness, swelling, heat, and pain, without any deep tissue damage. In the second stage, local skin tissue exhibited induration, mass, blisters, and no musculoskeletal destruction. Te third stage was superfcial tissue ulceration, which was characterized by local skin defects and abscess formation of skin and subcutaneous tissue pus. Te fourth stage was a deep ulcer, not only skin, subcutaneous tissue necrosis, and ulcer but also necrosis of skeletal muscle destruction. Stage fve was deep damage. Stage 6 was defned as a deep tissue injury. Figure 2 shows the comparison of clinical efcacy between the two groups, and Figure 3 shows the comparison of treatment efective rate between the two groups. In the control group, 22 cases were recovered, 17 cases were effective, 9 cases were efective, and 12 cases were inefective. In the observation group, 32 cases were recovered, 18 cases were efective, 6 cases were efective, and 4 cases were inefective. Te number of recovered patients in the observation group was dramatically higher than that in the control group, and the number of inefective patients was dramatically lower than that in the control group (P < 0.05). Te ERs of groups A and B were 80% and 93.33%, respectively, suggesting statistically observable diferences (P < 0.05). Figure 4 shows a comparison of wound granulation tissues. In group A, 45 patients had good granulation tissue, 13 patients had fresh granulation tissue, and 2 patients had dull granulation tissue after treatment. After treatment, 53 patients in group B had good granulation tissue, 6 patients had fresh granulation tissue, and 1 patient had dull granulation tissue. Te number of patients with good granulation tissue in group B was much higher (P < 0.05). Figure 5 shows the comparison of wound exudation volume. In group A, after treatment, there were 47 cases with a small amount of wound exudation, 9 cases with a medium amount of wound exudation, and 4 cases with a large amount of wound exudation. In group B, there were 51 cases with a small amount of wound exudation, 7 cases with a medium amount of wound exudation, and 2 cases with a large amount of wound exudation. Te number of patients with a small amount of wound exudation was dramatically higher than that of group A (P < 0.05). Figure 6 shows the comparison of the degree of wound edema. After treatment, 46 patients in group A had no edema. Tere were 9 patients with an edema degree of <1 cm and 5 patients with an edema degree of >1 cm. After treatment, 52 patients in group B had no edema. Tere were 6 patients with an edema degree of <1 cm and 2 patients with an edema degree of >1 cm. Te number of patients without edema in group B was higher, which was obviously observed (P < 0.05). Figure 7, serological indicators of patients were compared. No signifcant diference was found before the treatment in the levels of MMP-3, T1MP-1, VEGF, and TGF-B1 (P > 0.05). Te pretreatment levels of MMP-3, VEGF, and TGF-β1 were dramatically increased for all patients in the diferent groups, but this phenomenon in group B was more visible (P < 0.05). After treatment, the T1MP-1 level decreased for all patients, and this phenomenon was not as obvious as that in the other groups in group A (P < 0.05). Figure 8 shows the comparison of the area of hand pressure injury between the two groups before and after treatment, and Figure 9 shows

Discussion
A pressure injury is an injury caused by various pressures on the body. Pressure, shear force, and friction force all cause pressure injury to patients [16]. Prolonged pressure on the body is not conducive to blood circulation. Ischemia and hypoxia cause nutritional defciency, difcult wound recovery, tissue damage, and kidney necrosis [17]. Western medicine mainly promotes wound recovery by debridement and surgical treatment, while traditional Chinese medicine promotes wound healing by applying traditional Chinese medicine. Te application of traditional Chinese medicine has low cost, simple operation, few side efects, and little damage to patients. It has good efects and high clinical application value. Among them, Dragon's Blood is a commonly used traditional Chinese medicine for the treatment of pressure injury, which can promote blood circulation, disperse blood stasis, relieve pain, stop bleeding, generate muscles, and collect sores. Te wound healing process consists of four stages, namely, hemostasis, infammation, proliferation, and remodeling, and many wound dressings and techniques have been developed to enhance the body's ability to close wounds and restore function to damaged tissues. Te growing threat of bacterial infections and chronic wound healing has triggered an urgent need for novel antimicrobial wound dressings. Shi et al. [18] developed a wound dressing for the treatment of infected wounds that can reduce the infammatory phase (by using gentamicin sulfate (GS)) and enhance the granulation phase (by adding platelet-rich plasma (PRP)), reduce the number of bacteria, inhibit proinfammatory factors, and enhance anti-infammatory factors. Tis study demonstrated the great potential of biocompatible wound dressings with the dual release of GS   No edema <1 cm >1 cm Figure 6: Comparison of wound edema degree between the two groups ( * denotes that compared with control patients, P < 0.05).

Evidence-Based Complementary and Alternative Medicine
and PRP for the treatment of chronic and infected wounds. In this study, the therapeutic efects of sterile gauze treatment and Dragon's Blood treatment on pressure hand injury were explored. Te results showed that the number of patients in the observation group who completely disappeared from local symptoms were dramatically higher than that in the control group, and the number of patients without clinical efects was dramatically lower than that in the control group (P < 0.05). Te efective rate of the control group was 80% and that of the observation group was 93.33%. Te effective rate of the observation group was dramatically higher than that of the control group (P < 0.05). It was concluded that Dragon's Blood was dramatically better than sterile gauze in the treatment of hand pressure injury and can promote the recovery of patients. After treatment, the number of patients with good granulation tissue in the observation group was dramatically greater than that in the control group (P < 0.05).     Figure 9: Comparison of healing time of hand pressure injury between the two groups ( * denotes that compared with control patients, P < 0.05). 6 Evidence-Based Complementary and Alternative Medicine After treatment, the number of patients with a small amount of exudation at the injury site in the observation group was dramatically greater than that in the control group (P < 0.05). After treatment, the number of patients without edema in the observation group was dramatically higher than that in the control group (P < 0.05). Tis shows that Dragon's Blood treatment can promote the generation of fbrocytes in pressure hand injury and promote wound recovery. Clearly, Dragon's Blood can promote wound recovery in patients with hand pressure injury, relieve edema, and reduce the amount of wound exudation. MMPs and TIMPs are involved in the degradation of various proteins in the extracellular matrix (ECM) and play important roles in angiogenesis, embryogenesis, morphogenesis, and tissue remodeling in wound repair. Te dynamic balance of MMPs and TIMPs has an important impact on wound repair [19]. Te ECM plays an important role in cell diferentiation, proliferation, morphological changes, and phenotypic expression. TGF-β1 is closely related to the growth and reproduction of fbrocytes, has a regulatory efect on the growth of vascular endothelial cells, can afect the formation of scars, and has an important role in wound recovery. VEGF can promote the division and proliferation of vascular endothelial cells and provide a material basis for the formation of blood vessels. TGF-β1 and VEGF are closely related to the generation of blood vessels. Dragon's Blood can promote the formation of fbroblasts and improve the epidermal repair ability near wounds by promoting the expression of VEGF. Ding et al. [20] explored the regulatory mechanism between TGF-β1 and VEGF and the generation of blood vessels and found that the overexpression of specifc protein 1 (SP1) or TGF-β1 increased the expression level and secretion of VEGF, and VEGF could promote the division and proliferation of vascular endothelial cells, providing a material basis for the formation of blood vessels. Te results of this study showed that there were no statistically signifcant diferences in MMP-3, T1MP-1, VEGF, and TGF-B1 levels between the two groups before treatment (P > 0.05). After treatment, the levels of MMP-3, VEGF, and TGF-B1 were dramatically increased, especially in the observation group (P < 0.05). Te level of T1MP-1 decreased, especially in the observation group (P < 0.05). After treatment, the area of pressure hand injury in the control group was 0.82 cm 2 and that in the observation group was 0.27 cm 2 . Te area of pressure hand injury in both groups was reduced, and the reduction in the observation group was greater (P < 0.05). Te healing time of pressure hand injury in the control group was 19.32 days and that in the observation group was 15.27 days. Te healing time of pressure hand injury in the observation group was dramatically shorter (P < 0.05). Dragon's Blood had a good efect on the treatment of hand pressure wounds, which is worthy of popularization and application.

Conclusion
In this study, the therapeutic efects of Dragon's Blood and sterile gauze in the treatment of pressure hand injury were compared, and the research signifcance and contribution were also analyzed. It was found that Dragon's Blood had a good efect on the treatment of pressure hand injury, and the efective rate was dramatically higher than that of sterile gauze dressing. In addition, the wound recovery was good, the amount of exudate in the wound was dramatically reduced, the degree of edema was alleviated, the area of the wound was dramatically reduced, and the wound recovered quickly. Dragon's blood has positive clinical signifcance and can provide treatment options for wound recovery in patients with pressure injury. Te limitation of this study is that it only compared the diferent efects of Dragon's Blood and sterile gauze, without comparing the therapeutic efects of other wound treatment drugs. In the future, it is necessary to compare more kinds of wound healing drugs to explore the best pressure injury treatment drugs.

Data Availability
Te data used to support the fndings of this study are included within the article.

Conflicts of Interest
Te authors declare that they have no conficts of interest.