Application of amniotic membranes in reconstructive surgery of internal organs—A systematic review and meta‐analysis

Abstract

Amniotic membrane (AM) has great potential as a scaffold for tissue regeneration in reconstructive surgery. To date, no systematic review of the literature has been performed for the applications of AM in wound closure of internal organs. Therefore, in this systematic review and meta‐analysis, we summarize the literature on the safety and efficacy of AM for the closure of internal organs. A systematic search was performed in MEDLINE‐PubMed database and OVID Embase to retrieve human and controlled animal studies on wound closure of internal organs. The Cochrane Risk of Bias tool for randomized clinical trials and the SYRCLE risk of bias tool for animal studies were used. Meta‐analyses (MAs) were conducted for controlled animal studies to assess efficacy of closure, mortality and complications in subjects who underwent surgical wound closure in internal organs with the application of AM. Sixty references containing 26 human experiments and 36 animal experiments were included. The MAs of the controlled animal studies showed comparable results with regard to closure, mortality and complications, and suggested improved mechanical strength and lower inflammation scores after AM application when compared to standard surgical closure techniques. This systematic review and MAs demonstrate that the application of AM to promote wound healing of internal organs appears to be safe, efficacious, and feasible.

The Regenerative Capacity of Tissue-Engineered Amniotic Membranes

“…A meta-analysis on the application of AM in reconstructive surgery showed no or a minimal foreign body response, low inflammation scores, and good epithelialization when the AM was applied in different human and animal models. 6 This is supported by preclinical research that shows that AM exhibits anti-inflammatory, 37−39 immunosuppressive, 40−42 antifibrotic, 43,44 antimicrobial, 45 and immunomodulatory properties. 8,40,46−48 Implantation of P4HB in a subcutaneous rat model showed a host response to the implant compared to sham surgery.…”

“…Tissue-engineered scaffolds can be introduced as a matrix for tissue ingrowth and can help to improve wound healing by providing a matrix on which cells can migrate, proliferate, and express physiological behavior. We identified amniotic membrane (AM) as a promising biomaterial for the reconstruction of VVF defects due to its good regenerative capacity, biocompatibility, gradual degradability, and availability. − AM promotes fetal-like scarless healing, provides a supporting matrixsimilar to the extracellular matrix (ECM)and contains different bioactive molecules, such as growth factors, cytokines, and protease inhibitors. , …”

Evaluation of the Effect of an Amniotic Membrane Derived Bio-Nano Product (LifeCell) on Human Endometrial Cells Proliferation and Gene Expression: An in-vitro Study

“…This substance provides a natural matrix for cell migration, proliferation, and differentiation, which are crucial for wound epithelialization. Due to the presence of HLA-G nonclassical HLA antigens, the AM is not attacked by the body's immune system, resulting in transient or mitigated in ammatory responses following its use [14]. AM has been studied as a regenerative material for skin [13] and has demonstrated safety, effectiveness, and applicability in improving and healing wounds in internal organs [14].…”

“…AlloGraft Amniotic Membrane has applications in the treatment of various conditions such as corneal ulcers, burn wounds, treatment-resistant wounds in patients with venous or chronic ulcers, mucosal ulcers, and more [11][12][13][14].…”

The Microcirculation of Vaginal Tissue in Women with Obstetric Vesicovaginal Fistula and Short-Term Effects of Surgical Repair on Microvascular Parameters

“…However, in light of the results of this study, i.e., relatively good vasculature, it is questionable whether angiogenic-inducing strategies will be beneficial to surgical outcomes. Other potential promising treatment options for VVF repair include tissue-engineered biomaterials (e.g., amnion) or tissue sealants (e.g., fibrin glue, cyanoacrylate, autologous cell injection, or other bioglues), although most of these innovations are still in a preclinical phase [25][26][27][28][29][30].…”