Elsevier

Burns

Volume 39, Issue 2, March 2013, Pages 349-353
Burns

Effect of fresh human amniotic membrane dressing on graft take in patients with chronic burn wounds compared with conventional methods

https://doi.org/10.1016/j.burns.2012.07.010Get rights and content

Abstract

Background

Burns are among the most devastating forms of injury. Nowadays the standard treatment for deep partial thickness and full-thickness burn is early excision and grafting, but this technique is not always feasible; and this leads to chronicity and microbial colonization of burn wounds. Interesting properties of human amniotic membrane made us use it in management of chronic infected burn wounds.

Methods

From January 2008 to September 2010, in a prospective clinical trail, 38 patients (76 limbs) with symmetric chronic burn wounds in both upper or lower limbs included in this study. Tissue cultures were taken from all the wounds. For the right, after debridement of granulation tissue and meshed split thickness skin grafting, the graft surfaces were covered with amniotic membrane dressing and in left limb wounds, after debridement, skin grafting was done in conventional method. 21 days later, the success rate of graft take was compared between two groups.

Results

The study group was composed of 76 limbs in 38 patients with mean age of 27.18 ± 6.38 and burn in 29.18 ± 7.23 TBSA%. The most common causes of the burn wounds chronicity in the selected patients was delayed admission due to poor compliance of the patients (44.8%). Staphylococcus was the most frequent isolate in wounds in our patients (62.85%). Mean graft take was observed in 90.13% of right upper limbs, and 67.36% of left upper limbs; which was significantly different (P < 0.001).

Conclusions

Our study showed that human amniotic membrane dressing significantly increases the success rate of graft take in chronic wounds, and it can be recommended as an important dressing in chronic burn wounds management, due to interesting anti-microbial, and better graft take effects.

Introduction

Burns are among the most common and devastating forms of injury in the world which consume large amounts of medical resources. Finding an appropriate material for dressing of burn wounds, remains a major concern, especially in extensive and deep skin defects, and wounds severely contaminated by microorganisms or poorly vascularized [1]. Nowadays the standard treatment for deep partial thickness and full-thickness burn is early excision and grafting [2], [3]. However because of patients’ general condition, limitation of autologous donor site in the patients with extensive burn wounds [3], poor equipments, and large number of admissions in some centres, this technique is not always possible; and this leads to high-incidence of chronic burn wounds specially in developing countries. The significant problem in delayed grafting technique is microbial colonization of the granulation tissue that reduces graft take, while increasing complications, mortalities, length of hospital stay, and cost [4]. The problem now arises is, how to go about applying skin graft on chronic-infected granulation tissue, which is controversial among the burn surgeons [5].

Availability, having all of the features of an ideal skin substitute [6], being economical, effective in superficial and limited size wounds, and antibacterial properties made us use human amniotic membrane in management of chronic infected burn wounds.

The present randomized clinical trial was to evaluate the effect of fresh amniotic membrane dressing on the graft take of chronic burn wounds comparing with conventional grafting methods.

Section snippets

Material and methods

From January 2008 to September 2010, in a prospective clinical trail, 38 patients (76 limbs) with chronic burn wounds (The wounds with more than two weeks after granulation tissue formation, shiny and slimy appearance according to the burn (Fig. 1) surgeon's diagnosis and infected due to positive wound tissue culture, ≥105 colony forming unit/gram of the tissue) in both limbs included in this study. All of the patients needed meshed split-thickness skin graft. Our excludion criteria were age

Results

The study group was composed of 76 limbs in 38 patients with mean age of 27.18 ± 6.38 and burn in 29.18 ± 7.23 TBSA%; the median time interval between burn trauma and surgery was 53 days in the patients (interquartile range: 46.5–60.25). The patients’ limbs were divided into the amniotic membrane and control groups.

The most common causes of the burn wounds chronicity in the selected patients was delayed admission due to poor compliance of the patients (44.8%) (Table 1).

Staphylococcus was the most

Discussion

Burns are among the most dramatic trauma in world, and require immediate specialized care in order to minimize morbidity and mortality [7]. Nowadays early excision and grafting (E&G) is the standard treatment for deep partial thickness and full-thickness burn [2], [3], but E&G is not feasible in many cases, specially in developing countries, which leads to chronicity of burn wounds.

Chronicity of the burn wounds is so frequent is some centres. The most common cause of burn wounds chronicity in

Conclusion

Our study showed that human amniotic membrane dressing significantly increases the success rate of graft take in old-infected wounds, and beside all the previous effects, human amniotic membrane can be recommended as an interesting dressing in old infected burn wounds management, due to its magical anti-microbial, and better graft take effects.

Conflict of interest

None declared.

Acknowledgements

We would like to thank Department of Surgery, Shiraz Burn Research Center, and Ghotbeddin Burn Hospital personnel for their cooperation in this work. It should be mentioned that, this survey is based on the thesis of Dr. Mandana Kiasat for finishing general surgery residency, in Shiraz University of Medical Science.

References (21)

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