Effect of fresh human amniotic membrane dressing on graft take in patients with chronic burn wounds compared with conventional methods
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.
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Human amniotic membranes as an allogenic biological dressing for the treatment of burn wounds: Protocol for a randomized-controlled study
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2020, BurnsCitation Excerpt :Native structure and preserved growth factors and living stem cells make FAM a promising amniotic product for tissue engineering [54,75,76]. A randomized clinical trial study on 38 patients (mean age of 27.18 ± 6.38 and burn in 29.18 ± 7.23 TBSA%) with chronic burn wounds show better graft take, healing and protection against post-burn infections [54]. FAM also show to have a great impact on chronic non-healing ulcers [75].
Amniotic membrane for treating skin graft donor sites: A systematic review and meta-analysis
2020, BurnsCitation Excerpt :Firstly, the AM contains various growth factors that can promote epithelialization and wound healing [2]. The AM also has an anti-inflammatory and bacteriostatic effect that other dressing materials do not [3,4]. Thirdly, the AM is thought to have an analgesic effect, although the mechanism is not fully understood.