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DiDomenico LA, Orgill DP, Galiano RD, Serena TE, Carter MJ, Kaufman JP, Young NJ, Zelen CM. Aseptically Processed Placental Membrane Improves Healing of Diabetic Foot Ulcerations: Prospective, Randomized Clinical Trial. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1095. [PMID: 27826487 PMCID: PMC5096542 DOI: 10.1097/gox.0000000000001095] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 08/31/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Allogeneic grafts derived from amnion/chorion are known to be efficacious in healing chronic diabetic foot ulcerations (DFUs). The goal of this study was to compare aseptically processed dehydrated human amnion and chorion allograft (dHACA) versus standard of care (SOC) in facilitating wound closure in nonhealing DFUs. METHODS Patients with DFUs treated with SOC (off-loading, appropriate debridement, and moist wound care) after a 2-week screening period were randomized to either SOC or wound-size-specific dHACA (AmnioBand, Musculoskeletal Transplant Foundation, Edison, N.J.) applied weekly for up to 12 weeks plus SOC. Primary endpoint was the percentage of wounds healed at 6 weeks between groups. RESULTS At 6 weeks, 70% (14/20) of the dHACA-treated DFUs healed compared with 15% (3/20) treated with SOC alone. Furthermore, at 12 weeks, 85% (17/20) of the DFUs in the dHACA group healed compared with 25% (5/20) in the SOC group, with a corresponding mean time to heal of 36 and 70 days, respectively. At 12 weeks, the mean number of grafts used per healed wound for the dHACA group was 3.8 (median 3.0), and mean cost of the tissue to heal a DFU was $1400. The mean wastage at 12 weeks was 40%. One adverse event and 1 serious adverse event occurred in the dHACA group; neither was graft related. Three adverse events and 1 serious adverse event occurred in the SOC group. CONCLUSION Aseptically processed dHACA heals diabetic foot wounds significantly faster than SOC at 6 and 12 weeks with minimal graft wastage.
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Affiliation(s)
- Lawrence A. DiDomenico
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Dennis P. Orgill
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Robert D. Galiano
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Thomas E. Serena
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Marissa J. Carter
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Jarrod P. Kaufman
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Nathan J. Young
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
| | - Charles M. Zelen
- From the Lower Extremity Institute for Research and Therapy, Youngstown, Ohio; Department of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass.; Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill.; Serena Group, Cambridge, Mass.; Strategic Solutions, Inc., Cody, Wyo.; *General Surgery, Premier Surgical, Brick, N.J.; †Martinsville Research Institute, Martinsville, Va.; and ‡Professional Education and Research Institute, Roanoke, Va
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Biologics in wound healing: repair versus regeneration. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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103
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Nicholas MN, Yeung J. Current Status and Future of Skin Substitutes for Chronic Wound Healing. J Cutan Med Surg 2016; 21:23-30. [PMID: 27530398 DOI: 10.1177/1203475416664037] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Chronic wounds, including diabetic ulcers, pressure ulcers, venous ulcers, and arterial insufficiency ulcers, are both difficult and expensive to treat. Conventional wound care may sometimes lead to suboptimal wound healing and significant morbidity and mortality for patients. The use of skin substitutes provides an alternative therapy showing superior efficacy and, in some cases, similar cost-effectiveness compared to traditional treatments. This review discusses the different types of currently available commercial skin substitutes for use in chronic wounds as well as the paucity of strong evidence supporting their use. It then delves into the limitations of these skin substitutes and examines the most recent research targeting these limitations.
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Affiliation(s)
| | - Jensen Yeung
- 2 Department of Dermatology, Women's College Hospital and Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,3 Division of Dermatology, University of Toronto, Toronto, ON, Canada
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104
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Zelen CM, Orgill DP, Serena T, Galiano R, Carter MJ, DiDomenico LA, Keller J, Kaufman J, Li WW. A prospective, randomised, controlled, multicentre clinical trial examining healing rates, safety and cost to closure of an acellular reticular allogenic human dermis versus standard of care in the treatment of chronic diabetic foot ulcers. Int Wound J 2016; 14:307-315. [PMID: 27073000 PMCID: PMC7949710 DOI: 10.1111/iwj.12600] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/10/2016] [Indexed: 02/06/2023] Open
Abstract
Acellular dermal matrices can successfully heal wounds. This study's goal was to compare clinical outcomes of a novel, open‐structure human reticular acellular dermis matrix (HR‐ADM) to facilitate wound closure in non‐healing diabetic foot ulcers (DFUs) versus DFUs treated with standard of care (SOC). Following a 2‐week screening period in which DFUs were treated with offloading and moist wound care, patients were randomised to either SOC alone or HR‐ADM plus SOC applied weekly for up to 12 weeks. At 6 weeks, the primary outcome time, 65% of the HR‐ADM‐treated DFUs healed (13/20) compared with 5% (1/20) of DFUs that received SOC alone. At 12 weeks, the proportions of DFUs healed were 80% and 20%, respectively. Mean time to heal within 12 weeks was 40 days for the HR‐ADM group compared with 77 days for the SOC group. There was no incidence of increased adverse or serious adverse events between groups or any adverse events related to the graft. Mean and median graft costs to closure per healed wound in the HR‐ADM group were $1475 and $963, respectively. Weekly application of HR‐ADM is an effective intervention for promoting closure of non‐healing DFUs.
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Affiliation(s)
- Charles M Zelen
- Department of Medical Education, Professional Education and Research Institute, Roanoke, VA, USA
| | - Dennis P Orgill
- Department of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Robert Galiano
- Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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105
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Ilic D, Vicovac L, Nikolic M, Lazic Ilic E. Human amniotic membrane grafts in therapy of chronic non-healing wounds. Br Med Bull 2016; 117:59-67. [PMID: 26764358 DOI: 10.1093/bmb/ldv053] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Human amniotic membrane (HAM) has been embraced as a natural wound dressing almost exclusively in ophthalmology. Only recently, emergence of commercial HAM products prompted its use in growing range of indications, especially treatment of chronic non-healing wounds. SOURCES OF DATA ClinicalTrials.gov database and International Clinical Trials Registry Platform searched with key words 'human amniotic membrane' and 'chronic wounds'. AREAS OF AGREEMENT HAM can be successfully used as a natural wound dressing to promote healing. AREAS OF CONTROVERSY It is still unclear, which preparation is more advantageous, cryopreserved HAM or dehydrated HAM. GROWING POINTS There are an increasing number of commercial HAM products and clinical trials for a variety of dermatological diagnoses. AREAS TIMELY FOR DEVELOPING RESEARCH In spite of easy procurement and low production costs, to our knowledge, there are currently only a few manufacturers of commercial HAM products tested in clinical trials for cutaneous wounds and all of them are located in the USA.
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Affiliation(s)
- Dusko Ilic
- Stem Cell Laboratories, Guy's Assisted Conception Unit, Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Ljiljana Vicovac
- Laboratory for Biology of Reproduction, Institute INEP, University of Belgrade, Banatska 31b, Zemun, Belgrade 11080, Serbia
| | - Milos Nikolic
- Division of Pediatric Dermatology, Department of Dermatovenereology, Faculty of Medicine, University of Belgrade, Pasterova 2, Belgrade 11000, Serbia
| | - Emilija Lazic Ilic
- Bone Marrow Transplantation Unit, Laboratory for Cryobiology, Mother and Child Healthcare Institute, Belgrade, Serbia
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Burkey B, Davis W, Glat PM. Porcine xenograft treatment of superficial partial-thickness burns in paediatric patients. J Wound Care 2016; 25:S10-5. [DOI: 10.12968/jowc.2016.25.sup2.s10] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- B. Burkey
- Stuart J. Hulnick, MD Burn Center, St. Christopher's Hospital for Children, 160 East Erie Avenue, Philadelphia, PA
- Drexel University College of Medicine
| | - W. Davis
- Stuart J. Hulnick, MD Burn Center, St. Christopher's Hospital for Children, 160 East Erie Avenue, Philadelphia, PA
- Drexel University College of Medicine
| | - P. M. Glat
- Stuart J. Hulnick, MD Burn Center, St. Christopher's Hospital for Children, 160 East Erie Avenue, Philadelphia, PA
- Drexel University College of Medicine
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107
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Zelen CM, Serena TE, Gould L, Le L, Carter MJ, Keller J, Li WW. Treatment of chronic diabetic lower extremity ulcers with advanced therapies: a prospective, randomised, controlled, multi-centre comparative study examining clinical efficacy and cost. Int Wound J 2015; 13:272-82. [PMID: 26695998 PMCID: PMC7949818 DOI: 10.1111/iwj.12566] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 11/22/2015] [Accepted: 11/25/2015] [Indexed: 02/01/2023] Open
Abstract
Advanced therapies such as bioengineered skin substitutes (BSS) and dehydrated human amnion/chorion membrane (dHACM) have been shown to promote healing of chronic diabetic ulcers. An interim analysis of data from 60 patients enrolled in a prospective, randomised, controlled, parallel group, multi-centre clinical trial showed that dHACM (EpiFix, MiMedx Group Inc., Marietta, GA) is superior to standard wound care (SWC) and BSS (Apligraf, Organogenesis, Inc., Canton, MA) in achieving complete wound closure within 4-6 weeks. Rates and time to closure at a longer time interval and factors influencing outcomes remained unassessed; therefore, the study was continued in order to achieve at least 100 patients. With the larger cohort, we compare clinical outcomes at 12 weeks in 100 patients with chronic lower extremity diabetic ulcers treated with weekly applications of Apligraf (n = 33), EpiFix (n = 32) or SWC (n = 35) with collagen-alginate dressing as controls. A Cox regression was performed to analyse the time to heal within 12 weeks, adjusting for all significant covariates. A Kaplan-Meier analysis was conducted to compare time-to-heal within 12 weeks for the three treatment groups. Clinical characteristics were well matched across study groups. The proportion of wounds achieving complete closure within the 12-week study period were 73% (24/33), 97% (31/32), and 51% (18/35) for Apligraf, EpiFix and SWC, respectively (adjusted P = 0·00019). Subjects treated with EpiFix had a very significant higher probability of their wounds healing [hazard ratio (HR: 5·66; adjusted P: 1·3 x 10(-7) ] compared to SWC alone. No difference in probability of healing was observed for the Apligraf and SWC groups. Patients treated with Apligraf were less likely to heal than those treated with EpiFix [HR: 0·30; 95% confidence interval (CI): 0·17-0·54; unadjusted P: 5·8 x 10(-5) ]. Increased wound size and presence of hypertension were significant factors that influenced healing. Mean time-to-heal within 12 weeks was 47·9 days (95% CI: 38·2-57·7) with Apligraf, 23·6 days (95% CI: 17·0-30·2) with EpiFix group and 57·4 days (95%CI: 48·2-66·6) with the SWC alone group (adjusted P = 3·2 x 10(-7) ). Median number of grafts used per healed wound were six (range 1-13) and 2·5 (range 1-12) for the Apligraf and EpiFix groups, respectively. Median graft cost was $8918 (range $1,486-19,323) per healed wound for the Apligraf group and $1,517 (range $434-25,710) per healed wound in the EpiFix group (P < 0·0001). These results provide further evidence of the clinical and resource utilisation superiority of EpiFix compared to Apligraf for the treatment of lower extremity diabetic wounds.
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Affiliation(s)
- Charles M Zelen
- Professional Education and Research Institute, Roanoke, VA, USA
| | | | - Lisa Gould
- Department of Plastic Surgery, Wound Recovery Center, Kent Hospital, Warwick, RI, USA
| | - Lam Le
- St. John Wound Care, Tulsa, OK, USA
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108
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Frykberg RG, Banks J. Challenges in the Treatment of Chronic Wounds. Adv Wound Care (New Rochelle) 2015; 4:560-582. [PMID: 26339534 PMCID: PMC4528992 DOI: 10.1089/wound.2015.0635] [Citation(s) in RCA: 1186] [Impact Index Per Article: 131.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
Significance: Chronic wounds include, but are not limited, to diabetic foot ulcers, venous leg ulcers, and pressure ulcers. They are a challenge to wound care professionals and consume a great deal of healthcare resources around the globe. This review discusses the pathophysiology of complex chronic wounds and the means and modalities currently available to achieve healing in such patients. Recent Advances: Although often difficult to treat, an understanding of the underlying pathophysiology and specific attention toward managing these perturbations can often lead to successful healing. Critical Issues: Overcoming the factors that contribute to delayed healing are key components of a comprehensive approach to wound care and present the primary challenges to the treatment of chronic wounds. When wounds fail to achieve sufficient healing after 4 weeks of standard care, reassessment of underlying pathology and consideration of the need for advanced therapeutic agents should be undertaken. However, selection of an appropriate therapy is often not evidence based. Future Directions: Basic tenets of care need to be routinely followed, and a systematic evaluation of patients and their wounds will also facilitate appropriate care. Underlying pathologies, which result in the failure of these wounds to heal, differ among various types of chronic wounds. A better understanding of the differences between various types of chronic wounds at the molecular and cellular levels should improve our treatment approaches, leading to better healing rates, and facilitate the development of new more effective therapies. More evidence for the efficacy of current and future advanced wound therapies is required for their appropriate use.
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109
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Brantley JN, Verla TD. Use of Placental Membranes for the Treatment of Chronic Diabetic Foot Ulcers. Adv Wound Care (New Rochelle) 2015; 4:545-559. [PMID: 26339533 PMCID: PMC4529081 DOI: 10.1089/wound.2015.0634] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/23/2015] [Indexed: 12/29/2022] Open
Abstract
Significance: Chronic diabetic foot ulcers (DFUs) remain a challenge for physicians to treat. High mortality rates for DFU patients have pointed to the low effectiveness of standard care and lack of quality wound care products. The composition (collagen-rich tissue matrix and endogenous growth factors and cells) and functional properties (anti-inflammatory, anti-bacterial, and angiogenic) of placental membranes are uniquely suited to address the needs of chronic wounds. This led to the commercialization of placental membranes, which are now widely available to physicians as a new advanced wound treatment option. Recent Advances: Progress in tissue processing and preservation methods has facilitated the development of placental products for wounds. Currently, a variety of commercial placental products are available to physicians for the treatment of chronic DFUs and other wounds. This review summarizes the key factors that negatively impact DFU healing (including social factors, such as smoking, vascular deficiencies, hyperglycemia, and other metabolic abnormalities), describes the structure and biology of placental membranes, and overviews commercially available placental products for wounds and data from the most recent DFU clinical trials utilizing commercial placental membranes. Critical Issues: Although the effects of diabetes on wound healing are complex and not fully understood, some of the key factors and pathways that interfere with healing have been identified. However, a multidisciplinary approach for the assessment of patients with chronic DFUs and guidelines for selection of appropriate treatment modalities remain to be implemented. Future Directions: The biological properties of placental membranes show benefits for the treatment of chronic DFUs, but scientific and clinical data for commercially available placental products are limited. Therefore, we need (1) more randomized, controlled clinical trials for commercial placental products; (2) studies that help to understand the timing of placental products' application and criteria for patient selection; and (3) studies comparing the functional properties of different commercially available placental products.
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Affiliation(s)
- Jonathan N. Brantley
- Department of Surgery, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Thomas D. Verla
- Department of Surgery, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
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Mrugala A, Sui A, Plummer M, Altman I, Papineau E, Frandsen D, Hill D, Ennis WJ. Amniotic membrane is a potential regenerative option for chronic non-healing wounds: a report of five cases receiving dehydrated human amnion/chorion membrane allograft. Int Wound J 2015; 13:485-92. [PMID: 25974156 PMCID: PMC7950060 DOI: 10.1111/iwj.12458] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/10/2015] [Accepted: 04/13/2015] [Indexed: 01/31/2023] Open
Abstract
A case series of five patients with a total of six chronic non-healing wounds (>30 day duration) were non-randomly selected to evaluate the performance, safety and handling properties of dehydrated human amnion/chorion membrane allograft, an amniotic membrane scaffolding product. The patients had lower extremity wounds that had previously failed standard of care within a university outpatient/inpatient wound healing programme. Five wounds treated with dehydrated amnion/chorion membrane allograft showed a mean 43% area reduction from baseline (51% median) at 3 weeks into treatment and completely healed with a 64-day median time to closure (SD ±27·6 days). One wound worsened at 3 weeks and was found to have a complete central vein obstruction that was treated with long-term mild compression but still eventually healed at 6 months. Removing this outlier, the four responding wounds had a 72% mean and 69% median change in area from baseline, at the 3 week point. All five patients received only one application of dehydrated human amnion/chorion membrane allograft, and there were no adverse events. The product was easy to use, administer and handle. In summary, dehydrated human amnion/chorion membrane allograft appears to be a safe, effective and easy to use therapy for chronic non-healing wounds. This study describes the details of these clinical cases and provides an overview of the current evidence on the use of amniotic tissue in clinical practice.
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Affiliation(s)
- Andrew Mrugala
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Audrey Sui
- Chicago College Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA.,Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Malgorzata Plummer
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Igor Altman
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Elaine Papineau
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Devn Frandsen
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.,Department of Wound Healing, Grand View Hospital, Sellersville, PA, USA
| | - Danielle Hill
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - William J Ennis
- Division of Vascular Surgery, Section of Wound Healing and Tissue Repair, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
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