Use of amniotic membrane transplantation in the treatment of venous leg ulcers

Abstract

Amniotic membrane (AM), the most internal placental membrane, has unique properties including antiadhesive effects, bacteriostatic, wound protection and pain-reduction properties, as well as epithelialization initialization capacities. Furthermore, AM is widely available and less costly than other bioengineered skin substitutes. In a prospective pilot study, we evaluated the safety, feasibility, and the effects on healing of AM graft in 15 patients with chronic venous leg ulcers. AM grafts were prepared from placentas harvested during cesarean section. All grafted AM had adhered to the wound bed 7 days after being applied with a 100% engraftment rate. The percentage of granulation tissue increased significantly (from 17% on day 0 to 69% on day 14, p<0.0001), along with a significant decrease of fibrinous slough (from 36% at day 0 to 16% at day 14, p<0.001). A significant clinical response occurred in 12 patients (80%) including complete healing (20%) in three during the 3-month follow-up period. The ulcer surface area decreased significantly from a mean value (+/- standard deviation) of 4.59 +/- 2.49 cm(2) at baseline to 2.91+/-2.01 cm(2) on day 30 (p<0.001). All patients experienced a significant reduction of ulcer-related pain rapidly after AM transplantation. No adverse events were recorded. AM transplantation seems to function as a safe substrate, promoting proper epithelialization while suppressing excessive fibrosis. Further advantages of biotherapy with AM are its easy and low-cost production, and that it can be applied as an ambulatory treatment without immobilization. AM transplantation may thus be considered to be an alternative method for treating chronic leg ulcers.

In utero repair of myelomeningocele with autologous amniotic membrane in the fetal lamb model

“…Several studies have demonstrated the positive woundhealing effects of amnion for chronic wounds such as lower extremity ulcers, full-thickness wounds, and necrotizing infections [6][7][8][9][10]; however, the opposite was seen in our studies, as surgical wounds failed to heal in lambs repaired with AM. From our two decades of prior fetal sheep experiments, we know that a fetal lamb will heal almost any wound, and it has been suggested that this is secondary to regenerative properties of the fetus [24].…”

“…A prospective study using amnion in the treatment of venous ulcers demonstrated improved epithelialization and decreased fibrosis [6]. Another study found a decrease in fibrosis secondary to inhibition of TGF-β with amnion [23].…”

“…These properties have led to its use in diverse surgical settings, including ophthalmology and wound care [3][4][5][6][7][8][9][10]. Based on anecdotal experience and extensive literature supporting the anti-inflammatory and epithelialization-promoting properties of AM, we hypothesized that the use of autologous AM during in utero MMC repair would provide improved protection to the spinal cord.…”

Amniotic Membrane Scaffolds Enable the Development of Tissue-Engineered Urothelium with Molecular and Ultrastructural Properties Comparable to that of Native Urothelium

“…The AM has been successfully applied in a variety of clinical studies, such as management of burns 7 and ulcers, 8 tissue reconstruction of the vagina, 9 and prevention of postoperative adhesions, 10 but is still most widely used in ophthalmology for ocular surface reconstruction. [11][12][13] The AM can be used as a scaffold either with the amniotic epithelium (epithelial AM [eAM]) or without it (denuded AM [dAM]).…”

Repair of Oronasal Fistulae by Interposition of Multilayered Amniotic Membrane Allograft

“…Amniotic membrane is currently used for reconstruction of the ocular surface, 36 abdominal wall, 26 urinary bladder, 37 leg ulcers, 38 and burns. 39 It exhibits anti-inflammatory effects and has low immunogenicity.…”