Human Amniotic Membrane vs Collagen in the Treatment of Superficial Second-degree Burns in Children

Abstract

Objective. The authors compared a 1-time application of bovine collagen and human amniotic membrane (HAM) to treat children with superficial second-degree burns. Materials and Methods. A prospective, blinded, internally randomized trial of 43 children was conducted. Fresh HAM (prepared in-house at the Christian Medical College, Vellore) and bovine collagen were applied to different halves of each wound and dried naturally to form a hard, shell-like, so-called exoskeleton. The shell was shed as epithelialization occurred beneath it. Clinical examination and serial photographs were used to track progress until the wound healed completely, as well as at 3 and 6 months after the burn injury. Two burns surgeons blinded to the material used evaluated the resulting scars using the Vancouver Scar Scale. Results. The 43 children presented 3 hours after burn injury on average. A 1-time application was successful in 40 children (93%). After the dressing dried, all parents reported that their child was pain free and the exoskeleton could be handled over the burned area. A total of 16 children (37%) with a low-grade fever at the time of application were treated with simple antipyretic agents. Eight children reported itching at the dressing site. The dressing did not take or was removed in 3 children (7%). Minor serous collections occurred in 8 children who subsequently underwent aspiration. The median time to healing was 10 days in both study arms, with no significant difference in scarring between the 2 materials. Children with earlier shedding of the shell had significantly better scar quality (P <.001). Conclusions. Collagen and HAM are safe and provide a one-time ambulatory option for burn dressing with comparable time to healing and scarring. Earlier shedding of the dressing is predictive of better scar quality. Because HAM is inexpensive and simple to prepare and store, it is an excellent choice for use in economically disadvantaged areas where collagen may be unavailable.

Human Amniotic Membrane Usage from Bench to Bedside in Congenital Defects and Wounds in Paediatric Surgery: A Systematic Review

“…The epithelization of the wound happens beneath the hAM. Once the wound surface is completely re-epithelized the membrane is shed off as eschar 24 . 18.…”

“…The culture of glycerol stored hAM should be done 2 weekly, and if found positive the hAM should not be used for transplantation 29 . Alternatively, hAM can be kept in a sterile bottle with an antibiotic (Gentamycin and Crystalline Penicillin in Normal Saline) and antifungal agents for one Week at 4°C 24 . Some authors used to preserve the hAM in embryo-preserving solutions used during infertility treatment.…”

“…Cost Analysis: Cunha et al calculated the cost of time consumed in preparing fresh AM with the calculation of antibiotics, manpower and infrastructure needed to preserve hAM at 4 degrees Celsius for one week. The calculated cost of one placenta was 300 Indian rupees 24 .…”

“…The advantages of hAM are its easy availability in large quantities at hospitals having maternal and child care facilities 17 . The hospital stay, infection rate, antibiotic duration, cost of dressing material or operation for split-thickness skin grafting, and anaesthesia risk are less in patients treated by use of hAM in either acute or chronic wounds, the hAM can be safely used in paediatric wounds 29,24 . The stem cell differentiation and antiadhesive properties of hAM are used in congenital birth defects having the risk of adhesive intestinal obstruction 42 .…”

Preparation of human amniotic membrane for transplantation in different application areas

“…The use of hAM has also been proven in the treatment of burns. It has been useful as a temporary epidermal substitute for covering wounds in the treatment of second-degree burns, and especially in children ( 49 , 132 , 133 ). Pain reduction, early wound drying and significantly accelerated wound healing with epithelialization are described as particular advantages ( 134 – 137 ).…”