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WOUNDS

WOUNDS

Amniotic membrane induces epithelialization in massive posttraumatic wounds (download)

Wound Repair Regen. 2010 Jul-Aug;18(4):368-77. doi: 10.1111/j.1524-475X.2010.00604.x.

Insausti CL1, Alcaraz A, García-Vizcaíno EM, Mrowiec A, López-Martínez MC, Blanquer M, Piñero A, Majado MJ, Moraleda JM, Castellanos G, Nicolás FJ.
1Unidad de Terapia Celular, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.

Amniotic membrane transplantation in the treatment of chronic lower limb ulcers

Amniotic membrane transplantation in the treatment of chronic lower limb ulcers 

Actas Dermosifiliogr. 2012 Sep;103(7):608-13. Epub 2012 May 10.

Alsina-Gibert M1, Pedregosa-Fauste S.
1Servicio de Dermatología, Hospital Clínic, Transplant Services Foundation, Universitat de Barcelona, Barcelona, Spain.

Abstract

INTRODUCTION: Approximately 1% of the general population have venous or arterial lower limb ulcers. These lesions can be treated with biological skin substitutes such as cadaver skin or tissue-engineered skin equivalents, but treatment fails in 25% of cases, resulting in pain and loss of patient autonomy, as well as increased morbidity and health care costs. In the treatment of corneal ulcers, amniotic membrane has been shown to have antimicrobial and bacteriostatic properties, and to protect the wound without eliciting an immune response. The same properties have been reported in the treatment of burns and postthrombotic ulcers.

OBJECTIVES: To assess the effectiveness of amniotic membrane transplantation in the treatment of refractory chronic leg ulcers.

PATIENTS AND METHODS: Amniotic membrane was grafted onto 4 refractory ulcers in 3 patients. The mean time required for partial and complete re-epithelialization was calculated by measuring the wound area at weeks 0, 4, 8, 12, and 16. Pain intensity was assessed at the same intervals using a visual analog scale.

RESULTS: Complete wound re-epithelialization was achieved for 1 ulcer by week 8; in the other 3 cases, there was a 50% reduction in size compared to baseline. At week 16, the mean reduction in wound size for the 4 ulcers was 81.93%. The corresponding reduction in pain intensity was 86.6%. No adverse effects were observed.

CONCLUSIONS: Amniotic membrane transplantation might be an effective alternative for the treatment of refractory chronic vascular ulcers on the lower limbs.

Copyright © 2011 Elsevier España, S.L. and AEDV. All rights reserved.
PMID: 22578292 [PubMed – indexed for MEDLINE]

Effect of amniotic membrane to reduce postlaminectomy epidural adhesion on a rat model 

Effect of amniotic membrane to reduce postlaminectomy epidural adhesion on a rat model 

J Korean Neurosurg Soc. 2011 Jun;49(6):323-8. doi: 10.3340/jkns.2011.49.6.323. Epub 2011 Jun 30.

Choi HJ1, Kim KB, Kwon YM.
1Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea.

Abstract

OBJECTIVE: Epidural fibrosis and adhesion are the main reasons for post-laminectomy sustained pain and functional disability. In this study, the authors investigate the effect of irradiated freeze-dried human amniotic membrane on reducing epidural adhesion after laminectomy on a rat model.

METHODS: A total of 20 rats were divided into two groups. The group A did not receive human amniotic membrane implantation after laminectomy and group B underwent human amniotic membrane implantation after laminectomy. Gross and microscopic findings were evaluated and compared at postoperative 1, 3 and 8 weeks.

RESULTS: The amount of scar tissue and tenacity were reduced grossly in group of rats with human amniotic membrane implantation (group B). On a microscopic evaluation, there were less inflammatory cell infiltration and fibroblast proliferation in group B.

CONCLUSION: This experimental study shows that implantation of irradiated freeze-dried human amniotic membrane reduce epidural fibrosis and adhesion after spinal laminectomy in a rat model.

PMID: 21887388 [PubMed] PMCID: PMC3158473

Amniotic membrane induces epithelialization in massive posttraumatic wounds

Amniotic membrane induces epithelialization in massive posttraumatic wounds 

Wound Repair Regen. 2010 Jul-Aug;18(4):368-77. doi: 10.1111/j.1524-475X.2010.00604.x.

Insausti CL1, Alcaraz A, García-Vizcaíno EM, Mrowiec A, López-Martínez MC, Blanquer M, Piñero A, Majado MJ, Moraleda JM, Castellanos G, Nicolás FJ.
1Unidad de Terapia Celular, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.

Abstract
Large-surface or deep wounds often become senescent in the inflammatory or proliferation stages and cannot progress to reepithelialization. This failure makes intervention necessary to provide the final sealing epithelial layer. The best current treatment is autologous skin graft, although there are other choices such as allogenic or autologous skin substitutes and synthetic dressings. Amniotic membrane (AM) is a tissue of interest as a biological dressing due to its biological properties and immunologic characteristics. It has low immunogenicity and beneficial reepithelialization effects, with antiinflammatory, antifibrotic, antimicrobial, and nontumorigenic properties. These properties are related to its capacity to synthesize and release cytokines and growth factors. We report the use of AM as a wound dressing in two patients with large and deep traumatic wounds. Negative pressure wound therapy followed by AM application was capable of restoring skin integrity avoiding the need for skin graft reconstruction. AM induced the formation of a well-structured epidermis. To understand this effect, we designed some assays on human keratinocyte-derived HaCaT cells. AM treatment of HaCaT induced ERK1/2 and SAP/JNK kinases phosphorylation and c-jun expression, a gene critical for keratinocytes migration; however, it did not affect cell cycle distribution. These data suggest that AM substantially modifies the behavior of keratinocytes in chronic wounds, thereby allowing effective reepithelialization.

PMID: 20636551 [PubMed – indexed for MEDLINE]

Amniotic membrane grafting in patients with epidermolysis bullosa with chronic wounds 

Amniotic membrane grafting in patients with epidermolysis bullosa with chronic wounds 

J Am Acad Dermatol. 2010 Jun;62(6):1038-44. doi: 10.1016/j.jaad.2009.02.048.

Lo V1, Lara-Corrales I, Stuparich A, Pope E.
1Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.

Abstract

BACKGROUND: Severe forms of epidermolysis bullosa (EB) are characterized by chronic, nonhealing wounds.

OBJECTIVE: We sought to evaluate the usefulness of amniotic membranes in patients with EB.

METHODS: A retrospective chart review of patients with EB who were treated with amniotic membranes (two patients, 8 applications) was conducted. The primary outcome measure was number of days to complete healing, and the secondary outcome measures were a qualitative wound score, a visual analog scale score, and potential adverse effects.

RESULTS: The number of days to detect a significant clinical response, defined as greater than 50% improvement, was 40.3 +/- 21.2 days. The median qualitative wound score was 2 (range 0-5). The mean visual analog scale score at last follow-up was 31.4 +/- 26.8. No adverse events were noted.

LIMITATIONS: Retrospective design, healing assessed by comparing photographs, and partial grafting of some wounds were limitations.

CONCLUSION: This proof-of-concept study revealed the potential usefulness of amniotic membrane grafting in promoting healing of chronic wounds in patients with EB.

Copyright 2009 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
PMID: 20466177 [PubMed – indexed for MEDLINE]

Amnion in the treatment of pediatric partial-thickness facial burns

Amnion in the treatment of pediatric partial-thickness facial burns 

Burns. 2008 May;34(3):393-9. Epub 2007 Oct 24.

Branski LK1, Herndon DN, Celis MM, Norbury WB, Masters OE, Jeschke MG.
1Shriners Hospital for Children and University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, USA.

Abstract

BACKGROUND: Wound coverage for second-degree burns remains a clinical challenge. Human amniotic membranes have been used for many years in the treatment of burns; however, no large prospective clinical trials have been published. In this article, we present a novel and standardized procurement and processing method for amnion and investigate, whether the use of this biological dressing is safe and may represent a new therapeutic option for children with partial-thickness facial burns compared to standard topical treatment.

METHODS: Patients with partial-thickness burns of the face, neck and head admitted between 2003 and 2005 were included in this study. They were divided into two groups to receive either amnion (n=53) or topical antimicrobials (n=49). Demographics (age, gender, ethnicity, TBSA, burn areas), length of hospital stay (LOS), rate of infections (RI), time to total healing, and frequency of dressing changes were compared between the two groups. The long-term outcome was assessed in nine patients in the amnion group and eight patients in the topical group, who returned for up to 12-month follow-up visits.

RESULTS: Patients in the amnion group had significantly less dressing changes then in the control group (p<0.05). Time to healing, length of stay and the development of hypertrophic scarring was not different between the groups. Use of amnion was not associated with an increased risk of local infection.

CONCLUSION: This study indicates that amnion is safe and has advantages as wound coverage for second-degree facial burns compared to the standard topical ointments. Further studies with the use of amniotic membranes on the trunk and the extremities, as well as for coverage of grafted third-degree burns, have yet to be performed.

PMID: 17920202 [PubMed – indexed for MEDLINE]

Use of amniotic membrane transplantation in treatment of venous leg ulcers 

Use of amniotic membrane transplantation in treatment of venous leg ulcers 

Wound Repair Regen. 2007 Jul-Aug;15(4):459-64.

Mermet I1, Pottier N, Sainthillier JM, Malugani C, Cairey-Remonnay S, Maddens S, Riethmuller D, Tiberghien P, Humbert P, Aubin F.
1Université de Franche Comté, Department of Dermatology, University Hospital and Medical School, Besançon, France.

Abstract
Amniotic membrane (AM), the most internal placental membrane, has unique properties including antiadhesive effects, bacteriostatic, wound protection and pain-reduction properties, as well as epithelialization initialization capacities. Furthermore, AM is widely available and less costly than other bioengineered skin substitutes. In a prospective pilot study, we evaluated the safety, feasibility, and the effects on healing of AM graft in 15 patients with chronic venous leg ulcers. AM grafts were prepared from placentas harvested during cesarean section. All grafted AM had adhered to the wound bed 7 days after being applied with a 100% engraftment rate. The percentage of granulation tissue increased significantly (from 17% on day 0 to 69% on day 14, p<0.0001), along with a significant decrease of fibrinous slough (from 36% at day 0 to 16% at day 14, p<0.001). A significant clinical response occurred in 12 patients (80%) including complete healing (20%) in three during the 3-month follow-up period. The ulcer surface area decreased significantly from a mean value (+/- standard deviation) of 4.59 +/- 2.49 cm(2) at baseline to 2.91+/-2.01 cm(2) on day 30 (p<0.001). All patients experienced a significant reduction of ulcer-related pain rapidly after AM transplantation. No adverse events were recorded. AM transplantation seems to function as a safe substrate, promoting proper epithelialization while suppressing excessive fibrosis. Further advantages of biotherapy with AM are its easy and low-cost production, and that it can be applied as an ambulatory treatment without immobilization. AM transplantation may thus be considered to be an alternative method for treating chronic leg ulcers.

PMID: 17650088 [PubMed – indexed for MEDLINE]

Histological evaluation of rabbit gingival wound healing transplanted with human amniotic membrane

Histological evaluation of rabbit gingival wound healing transplanted with human amniotic membrane 

Int J Oral Maxillofac Surg. 2006 Mar;35(3):247-51. Epub 2006 Jan 18.

Rinastiti M1, Harijadi, Santoso AL, Sosroseno W.
1Department of Conservative Dentistry, Faculty of Dentistry, Gadjah Mada University, Yogyakarta 55281, Indonesia.

Abstract
Human amniotic membrane has been used as a material to accelerate wound healing and reconstruct damaged organs. The aim of the present study was to assess histologically human amniotic membrane transplantation on rabbit’s gingival wound. Three- to 4-month-old male rabbits were divided into 2 groups, i.e., control (group I) and amniotic membrane-transplanted animals (group II). Buccal gingival wounds were created by a punch-biopsy instrument and covered by a 5-layered human amniotic membrane for group II or left uncovered for group I. Gingival biopsies were taken at days 1, 3, 5, 7 and 10, processed for paraffin sections and stained with haematoxylin-eosin or von Gieson. Thickness of epithelial layer, the number of polymorphonuclear cells (PMN), fibroblasts and new blood vessels as well as density of collagen fibres were assessed. The results showed that the number of fibroblasts and new blood vessels, but not PMN, from group II was higher than that from group I (P < 0.05). Similarly, the epithelial thickness and density of collagen fibres from group II were significantly higher than those from group I (P < 0.05). The results of the present study indicate that amniotic membrane transplantation may induce rapid epithelialization and both granulation tissue and collagen formation but suppress inflammation, suggesting that amniotic membrane transplantation may promote rapid gingival wound healing in rabbits compared to secondary healing.

PMID: 16386878 [PubMed – indexed for MEDLINE]

BURNS

BURNS

The role of allogenic amniotic membrane in burn treatment (download)

J Burn Care Res. 2008 Nov-Dec;29(6):907-16. doi: 10.1097/BCR.0b013e31818b9e40.

Kesting MR1, Wolff KD, Hohlweg-Majert B, Steinstraesser L.
1Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar, Technische Universität München, München, Germany.

Use of amniotic membrane, amniotic fluid, and placental dressing in advanced burn patients 

Use of amniotic membrane, amniotic fluid, and placental dressing in advanced burn patients 

Chapter, Regenerative Medicine Using Pregnancy-Specific Biological Substances, pp 383-394, Date: 29 November 2010

N. Bhattacharya
Department of General Surgery, Obstetrics and Gynaecology and Clinical Immunology, Advanced Medical Research Institute, Gol Park, B.P. Poddar Hospital and Vidyasagore Hospital, Kolkata 700034, India

Abstract

INTRODUCTION: The development of wound infections is the most common cause of mortality and morbidity among burn patients. A variety of dressings have been used to cover and reduce burn wound sepsis and promote wound healing. The aim of the present study was to examine the effectiveness of composite and judicious use of different stem cell-rich pregnancy-specific biological substances (PSBS) such as freshly collected amniotic membrane, amniotic fluid, and the placenta in case of extensive burn wound.

MATERIALS and METHODS: Patients with more than 20% wound were admitted, and options were given for conservative management with PSBS dressing at a nonteaching hospital or provided with referral facility at the burns unit of another tertiary-level government hospital. Those who opted for treatment with PSBS (procured from hepatitis-, syphilis- and HIV-seronegative mothers having undergone cesarean deliveries) were treated initially at Bejoygarh State Hospital (1999–2006) and the same regimen was followed later at Vidyasagore Hospital (2006–2009). The area affected included both partial to complete thickness thermal burns. Patients suffering from chemical burns, or burned areas in sensitive parts of the body such as the genitals or face, were also included in this study from 1999 to 2009.
Result and analysis: Initially, 97 patients were randomly recruited for the present study of the utility of PSBS in the burn management. Of these, 33 patients, who did not agree to the PSBS protocol, were transferred to the burn unit of a tertiary-care hospital and were treated with broad spectrum antibiotics, application of silver sulfadiazine cream with electrolytes, and other supportive drugs to combat initial shock and infection till the patient was fit for autologous skin graft.
The rest, i.e., 64 burn patients (male 24, age 2–96 years, mean 36 ± 5.4 years and female 40, age 7–68 years, mean 32 ± 5.7 years) with 26–76% of total body surface area calculated on the basis of the famous rule of nine were enrolled in the present study for PSBS treatment (1999–2009).
Patients were treated with placenta (Step 1). After washing the burn site initially with normal saline, it was followed by gentle rubbing of the burned area with a freshly collected placenta’s maternal attachment site as a dressing material. This move may have a positive cytokine impact on the process of healing. Then, the burn site was washed with freshly collected amniotic fluid as a cell therapy source (because of its rich content of epithelial and mesenchymal stem cell component, leaving aside its antibacterial propensity as a helpful adjuvant) (Step 2). At last amniotic membrane is applied at the affected area (Step 3), as a temporary biological wound cover to expedite the healing and also to reduce the exudation, pain, and infection at the burn wound site with judicious application mode, i.e., chorionic side to augment vasculogenesis in early wound and the amniotic side to promote epithelialization lately. This is an effective step to augment the cell therapy component of the amniotic fluid.

CONCLUSION: The globally used skin substitutes currently available are costly and many are not universally available. The easily available and simple utilization of the biological waste generated from obstetric wards for the burn victims is very effective and rewarding. Use of stem cell-rich PSBS regimen has a profound regenerative impact in case of burn irrespective of the degree of burn. Its wider application is recommended on the basis of our experience of the present study, which has been carried out for 10 years (1999–2009).

DOI: 10.1007/978-1-84882-718-9_37, © Springer-Verlag London Limited 2011

The role of allogenic amniotic membrane in burn treatment

The role of allogenic amniotic membrane in burn treatment 

J Burn Care Res. 2008 Nov-Dec;29(6):907-16. doi: 10.1097/BCR.0b013e31818b9e40.

Kesting MR1, Wolff KD, Hohlweg-Majert B, Steinstraesser L.
1Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar, Technische Universität München, München, Germany.

Abstract
Amniotic membrane (AM) has been used in burns for nearly 100 years. The purpose of this article is to give a comprehensive review of the English literature published in the last two decades (1987–2007) to present the current state of this therapy form. Three medical databases (PubMed, Medline, The Cochrane Library) and specific burn journals were electronically screened for relevant articles using carefully selected retrieval strategies and keywords (AM, amnion grafts, burns, wound dressing, amnion banking). Bibliographies of relevant articles were analyzed for additional pertinent publications. After exclusion of articles which referred to the use of AM in reconstructive and ophthalmologic surgery, the inquiry yielded 31 relevant articles in English language dealing with AM and burns. There was no publication fulfilling the criteria of evidence level I, 6 articles had evidence level II, 10 had evidence level III, 6 had evidence level IV, and 9 were merely narrative (level V). The review testifies to–in view of good tissue practice–heightened use of processed AM in burns, especially in the last decade. Randomized clinical trials favored the use of amnion in burns in the first place for promotion of wound healing and in the second place for its comfortable and less dressing changes. Antimicrobial effects, pain relief, reduction of fluid, and scar formation were demonstrated additionally.

PMID: 18849850 [PubMed – indexed for MEDLINE]

Amnion in the treatment of pediatric partial-thickness facial burns

Amnion in the treatment of pediatric partial-thickness facial burns 

Burns. 2008 May;34(3):393-9. Epub 2007 Oct 24.

Branski LK1, Herndon DN, Celis MM, Norbury WB, Masters OE, Jeschke MG.
1Shriners Hospital for Children and University of Texas Medical Branch, 815 Market Street, Galveston, TX 77550, USA.

Abstract

BACKGROUND: Wound coverage for second-degree burns remains a clinical challenge. Human amniotic membranes have been used for many years in the treatment of burns; however, no large prospective clinical trials have been published. In this article, we present a novel and standardized procurement and processing method for amnion and investigate, whether the use of this biological dressing is safe and may represent a new therapeutic option for children with partial-thickness facial burns compared to standard topical treatment.

METHODS: Patients with partial-thickness burns of the face, neck and head admitted between 2003 and 2005 were included in this study. They were divided into two groups to receive either amnion (n=53) or topical antimicrobials (n=49). Demographics (age, gender, ethnicity, TBSA, burn areas), length of hospital stay (LOS), rate of infections (RI), time to total healing, and frequency of dressing changes were compared between the two groups. The long-term outcome was assessed in nine patients in the amnion group and eight patients in the topical group, who returned for up to 12-month follow-up visits.

RESULTS: Patients in the amnion group had significantly less dressing changes then in the control group (p<0.05). Time to healing, length of stay and the development of hypertrophic scarring was not different between the groups. Use of amnion was not associated with an increased risk of local infection.

CONCLUSION: This study indicates that amnion is safe and has advantages as wound coverage for second-degree facial burns compared to the standard topical ointments. Further studies with the use of amniotic membranes on the trunk and the extremities, as well as for coverage of grafted third-degree burns, have yet to be performed.

PMID: 17920202 [PubMed – indexed for MEDLINE]

GENERAL SURGERY

GENERAL SURGERY

The Effects of Human Amniotic Membrane on Healing of Colonic Anastomosis in Dogs (download)

Annals of Colorectal Research. 2013 December; 1(3): 97-100. , DOI: 10.17795/acr-16139

Neda Najibpour1; Mohammad Bagher Jahantab2 ; Massood Hosseinzadeh3; Reza Roshanravan3 ; Sam Moslemi2; Salar Rahimikazerooni3; Ali Reza Safarpour4; Leila Ghahramani3; and Seyed Vahid Hosseini3,
1Department of Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran, 2Department of Surgery, Shiraz University of Medical Sciences, Shiraz, IR Iran, 3Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran, 4Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions

Eur Spine J. 2009 Aug;18(8):1202-12. doi: 10.1007/s00586-009-1013-x. Epub 2009 Apr 30.

Tao H1, Fan H.
1Department of Orthopaedics and Traumatology, Xi-jing Hospital, The Fourth Military Medical University, 710032, Xi’an, China.

Abstract
Postlaminectomy epidural adhesion is implicated as a main cause of “failed back surgery syndrome” and associated with increased risk of complications during revision surgery. Various materials acting as mechanical barriers to reduce fibroblasts infiltration into epidural space have met with limited success. In present research, amniotic membrane (AM) was studied to investigate its effects on reducing epidural scar adhesion after laminectomy in a canine model. Laminectomy sites were created at L-1, L-3, L-5, and L-7 levels in 24 adult mongrel dogs. Freeze dried AM (FAM), cross-linked AM (CAM), and autologous free fat (AFF) were implanted, respectively, at a randomly assigned site in each dog with the remaining untreated site serving as internal control. The animals were sacrificed at 1, 6, and 12 weeks postoperatively. Then, gross pathologic observation including scar amount and adhesion tenacity, qualitative histology evaluation, and quantitative histology analysis were compared. Gross observation demonstrated that scar amount and adhesion tenacity of CAM group were significantly lower in comparison with those of FAM and non-treatment groups. A white, slightly vascularized CAM layer covered the dura mater without tenacious scar adhesion. The histology analysis also indicated reduced fibroblasts infiltration and consequent epidural fibrosis, which were similar to the results of AFF group. In conclusion, the CAM is effective in reducing epidural fibrosis and scar adhesion after laminectomy in canine model. It is a promising biomaterial for future clinical applications.

PMID: 19404691 [PubMed – indexed for MEDLINE] PMCID: PMC2899499

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