Human amniotic membranes as an allogenic biological dressing for the treatment of burn wounds: Protocol for a randomized-controlled study

Strategies for Optimizing Acute Burn Wound Therapy: A Comprehensive Review

Recent advancements in acute burn wound therapy are transforming the management of burn injuries, with a focus on improving healing times, graft integration, and minimizing complications. However, current clinical treatments face significant challenges, including the difficulty of accurately assessing wound depth and tissue viability, which can lead to suboptimal treatment planning. Traditional closure methods often struggle with issues such as delayed wound closure, limited graft survival, inadequate tissue regeneration, and insufficient vascularization. Furthermore, managing infection and minimizing scarring remain persistent obstacles, impacting functional recovery and aesthetic outcomes. Key areas of innovation include advanced imaging techniques that enable more precise assessment of wound depth, size, and tissue viability, allowing for more accurate treatment planning. In addition, new closure strategies are being developed to accelerate wound closure, enhance graft survival, and address challenges such as tissue regeneration, vascularization, and infection prevention. These strategies aim to optimize both functional recovery and aesthetic outcomes, reducing scarring and improving the quality of life for burn patients. While promising, these emerging techniques require further research and clinical validation to refine their effectiveness and expand their accessibility. Together, these innovations represent a significant shift in acute burn care, offering the potential for more personalized, efficient, and effective treatments.

Alginate-Based Hydrogels with Amniotic Membrane Stem Cells for Wound Dressing Application

Objective

Chronic wounds are a common clinical problem that necessitate the exploration of novel regenerative therapies. We report a method to investigate the in vitro wound healing capacity of an innovative biomaterial, which is based on amniotic membrane-derived stem cells (AMSCs) embedded in an alginate hydrogel matrix. The aim of this study was to prepare an sodium alginate-based hydrogel, cross-linked calcium chloride (CaCl2) with the active ingredient AMSC (AMSC/Alg-H) and to evaluate its in vitro effectiveness for wound closure.

Methods

This hydrogel preparation involved combining sterile solutions of AMSC, sodium alginate, and CaCl2, followed by rinsing with serum-free media. The cells were cultured in different 6-well plates, namely sodium alginate, calcium chloride, AMSC, Alg-H, and AMSC/Alg-H, in complete medium with 10% FBS. The hydrogel was successfully formulated, as confirmed by characterization techniques including Scanning Electron Microscopy (SEM), Fourier Transform Infrared (FTIR) spectroscopy, Differential Scanning Calorimetry (DSC), Cytotoxicity Studies, TGF-β1 Level Measurement by ELISA, and Cell Scratch Wound Assay.

Results

Cryo-EM characterization of the Alg-H preparation successfully demonstrated the encapsulation of MSCs. FTIR and DSC analyses indicate that crosslinking transpires in Alg-H encapsulating AMSC. The AMSC/Alg-H preparation showed no significant difference in toxicity compared to HaCaT cells (p < 0.05), indicating it was not toxic to HaCaT cells. Furthermore, in the scratch wound assay test at 24 hours, the AMSC/Alg-H preparation achieved 100% wound closure, outperforming both AMSC and Alg-H alone. In vitro assessment revealed that AMSC/Alg-H significantly enhanced key wound healing processes, including cell proliferation and migration, compared to Alg-H.

Conclusion

Our study demonstrated the promising potential of AMSC/Alg-H as an enhanced regenerative therapy for in vitro wound healing. AMSC/Alg-H was able to maintain the viability of AMSCs and facilitate the formation of tissue-like structures.

Advantage of Amnion Dressing (Biological Dressing) + Silver Sulfadiazine Cream vs. Standard Silver Sulfadiazine Cream Dressings in Acute Deep Second-Degree and Third-Degree Burn Wounds: a Single Center Experience

INTRODUCTION

This study compared the benefits of amnion dressing (biological dressing) + silver sulfadiazine cream with standard silver sulfadiazine cream dressings in treating deep second- and third-degree acute burn wounds.

METHODS

This prospective clinical trial was conducted on 50 patients with deep second- and third-degree burns who were admitted to Taleghani Hospital in Ahvaz, Iran. Participants were divided into two groups: the first one comprised subjects who received silver-amnion biological dressing (silver sulfadiazine 1%) and the second group consisted of patients treated with standard silver sulfadiazine cream dressings.

RESULTS

In the amnion-silver group, the average time required for graft readiness was eight days, compared to 11 days in the standard dressing group, which indicated a 27% reduction in recovery time. The treatment costs in the amnion-silver group were 20.8 Euro compared to 26.3 Euro for the standard dressing group, reflecting a 21% cost reduction. Narcotic consumption in the amnion-silver group was zero, but the average narcotic use in the standard dressing group was 50 mg of pethidine, revealing a 100% reduction. Based on the visual analog scale (VAS), the mean pain intensity was 4 in the amnion-silver group and 5.5 in the standard dressing group. Patient satisfaction was 85% in the amnion-silver group versus 60% in the standard dressing group. No infections were reported in the amnion-silver group, while three cases were observed in the standard dressing group.

CONCLUSION

The results of the present study indicate that amnion-silver dressing can be an effective and economical treatment option for wound healing. In the amnion-silver group versus standard group, a considerable reduction in recovery time was observed, which was also reflecting a cost reduction. Furthermore, the mean pain intensity was lower in the amnion-silver group than the standard dressing group. Patient satisfaction was higher in the amnion-silver group.

Exploring the therapeutic potential of different sources of mesenchymal stem cells: a novel approach to combat burn wound infections

The most prevalent and harmful injuries are burns, which are still a major global health problem. Burn injuries can cause issues because they boost the inflammatory and metabolic response, which can cause organ malfunction and systemic failure. On the other hand, a burn wound infection creates an environment that is conducive to the growth of bacteria and might put the patient at risk for sepsis. In addition, scarring is unavoidable, and this results in patients having functional and cosmetic issues. Wound healing is an amazing phenomenon with a complex mechanism that deals with different types of cells and biomolecules. Cell therapy using stem cells is one of the most challenging treatment methods that accelerates the healing of burn wounds. Since 2000, the use of mesenchymal stem cells (MSCs) in regenerative medicine and wound healing has increased. They can be extracted from various tissues, such as bone marrow, fat, the umbilical cord, and the amniotic membrane. According to studies, stem cell therapy for burn wounds increases angiogenesis, has anti-inflammatory properties, slows the progression of fibrosis, and has an excellent ability to differentiate and regenerate damaged tissue. Figuring out the main preclinical and clinical problems that stop people from using MSCs and then suggesting the right ways to improve therapy could help show the benefits of MSCs and move stem cell-based therapy forward. This review's objective was to assess mesenchymal stem cell therapy's contribution to the promotion of burn wound healing.

A Comparative Analysis of the Outcomes of Various Graft Types in Burn Reconstruction Over the Past 24 Years: A Systematic Review

Burn injuries, a major global health concern, result in an estimated 180,000 fatalities annually. Despite tremendous progress in treatment methods over the years, the morbidity and mortality associated with burns remain significant. Autologous skin grafting, particularly split-thickness skin grafting (STSG), has been a cornerstone in burn reconstruction, and it has facilitated survival and functional recovery for total body surface area (TBSA) significantly. However, the requirement for primary closure at the donor site due to the constraints of full-thickness donor harvesting continues to pose challenges. The introduction of dermal regenerative templates (DRT) in the late 1970s marked a substantial step forward in tissue engineering, addressing the inadequacy of dermal replacement with STSGs. This systematic review aimed to compare the outcomes of different graft types - bioengineered, autografts, allografts, and xenografts - in burn reconstruction over the last 24 years. The review focused on the pros and cons of each graft type, offering clinical insights grounded in experience and evidence. The approach involved a systematic review of studies published in English from January 2000 to January 2024, covering randomized controlled trials (RCTs), cohort studies, case-control studies, and case series. The participants comprised individuals of all ages who underwent burn reconstruction with skin grafts, specifically split-thickness grafts, full-thickness grafts, composite grafts, and epidermal grafts (autografts, allografts, and xenografts) and bioengineered grafts. The primary outcomes were functional and cosmetic results, patient satisfaction, graft survival, and complications. The risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2), the Newcastle-Ottawa Scale (NOS) for non-randomized studies, and the Canada Institute for Health Economics (IHE) quality appraisal tool for case series. Our initial search yielded a total of 1,995 articles, out of which 10 studies were selected for final analysis. Among the four clinical trials assessed, 75% showed a high risk of bias. The studies reviewed involved various graft types, with six studies (60%) concentrating on allografts, three (30%) on autografts, and one (10%) on bioengineered skin grafts. The outcomes were varied, underlining the intricate nature of burn wound management. Our evaluation revealed promising results for autologous-engineered skin substitutes and allografts but also highlighted methodological disparities among the studies included. The dominance of observational studies and the diversity of outcome measures present obstacles to direct comparisons. Future research should address these limitations, employing well-structured RCTs, standardized outcome measures, and exploring long-term outcomes and patient-specific factors. The rapidly evolving field of regenerative medicine offers great potential for novel grafting methods. This systematic review provides valuable insights into the diverse outcomes of burn reconstruction using different graft types. Autologous-engineered skin substitutes and allografts seem to hold significant promise, suggesting a possible shift in grafting techniques. However, methodological inconsistencies and the lack of high-quality evidence underscore the necessity for further research to fine-tune burn care approaches.

Amniotic Fluid and Placental Membranes as Sources of Stem Cells: Progress and Challenges 2.0

The aim of the second edition of this Special Issue was to collect both review and original research articles that investigate and elucidate the possible therapeutic role of perinatal stem cells in pathological conditions, such as cardiovascular and metabolic diseases, as well as inflammatory, autoimmune, musculoskeletal, and degenerative diseases [...].