Viable placental allograft as a biological dressing in the clinical management of full-thickness thermal occupational burns

Abstract

Rationale:Occupational burn injuries can be detrimental and difficult to manage. The majority of complex cases are referred and managed at regional burn centers where access to specialized care is available. As an alternative to hospitalization with staged surgical procedures, placental products may be used for outpatient medical management of these common burn injuries, especially if access to a regional burn center is limited or restricted.Fresh amnion has been a treatment of choice in burns for more than 100 years. As a biological covering with a broad scope of potential uses, human placental membranes represent a dressing that is particularly advantageous for burn therapy. Recent advances in tissue-preservation technology have allowed for the commercialization of placental amnion products.Patient concerns:To address several complications associated with burn injuries—contractures, scar formation, and pain—a viable cryopreserved placental membrane (vCPM) (Grafix—PRIME, Osiris Therapeutics, Inc., MD) retaining the anti-inflammatory, anti-fibrotic, and antimicrobial properties of fresh placental tissues was chosen for clinical use in the 2 cases reported, where both patients had restricted access to the regional burn center.Diagnoses:Two cases of work-related extremity burns presented to a local rural hospital for immediate post-injury assessment. The 1st case was of a man who sustained a 55.4 cm2 full-thickness 3rd degree thermal burn with exposed bone and tendon, to the left dorsal forefoot after having an industrial pressure washer caught on his work boot. The 2nd case was of a female who sustained a 4.7 cm2 full-thickness 3rd degree crush burn to the dorsum extensor surface of her dominant hand's index finger after applying 80-pounds per square inch of heated pressure from a hydraulic press.Interventions:Both burn patients elected to continue their care at the outpatient-based wound and hyperbaric center, receiving a combination of weekly ad libitum debridement, applications of vCPM, and occupational therapy.Outcomes:Both burns reached timely wound closure, and patients regained full range of motion of the affected limb, allowing for early return to work. The average number of allograft applications was 7.5, allowing both patients to return to work in an average of 63.5 days without adverse events or post-treatment complications.Lessons:The incorporation of this product in the treatment of these complex burns prevented amputation in one patient, and skin autografting and potential index finger contracture-formation in the second patient. The incorporation of vCPM in burn management may offer a new approach to outpatient burn management and may mitigate several of the complications seen post burn injury, leading to favorable patient outcomes.

Lung Surfactant Accelerates Skin Wound Healing: A Translational Study with a Randomized Clinical Phase I Study

“…In agreement with our results with lung surfactant, no graft related adverse events were found with amniotic membrane treatment in diabetic foot ulcers 54 , epidermolysis bullosa 55 or in burns 56 . Enhancement of granulation tissue formation and wound closure of arteriosclerotic foot sores or amelioration of atopic dermatitis by topical Alv treatment are preliminary observations of a pilot study that will be investigated in the next phase of clinical trials.…”

A case of Dupuytren’s disease managed with viable cryopreserved placental membrane adjunct to open palmar fasciectomy

“…No adverse events were recorded, including infection—a common complication occurring in up to 18% cases post OPF [ 3 ]. Pain reduction of 8/10 to 0/10 led to reduced use of narcotics post-surgery, a phenomenon also reported in burn hand cases treated with vCPM [ 6 ].…”

“…Here, vCPM was applied proximally in the surgical dissection space over the MCP joint with the goal of preventing contracture reoccurrence. Previously reported data showed that vCPM application to a hand burn resulted in absence of contracture with ROM restoration and absence of scar reformation when used as an adjunct to chronic keloid resection [ 6 , 7 ]. Notably in this DD patient, the distal part of the surgical incision without vCPM underlay required triamcinolone injection due to post-op fascia thickening.…”

3D Bioprinting of Functional Skin Substitutes: From Current Achievements to Future Goals

“…In particular, it would act as a sustained delivery system of growth factors, which are key factors in wound healing regulation, and their exogenous administration has been proven to accelerate healing [ 35 ]. Examples of cells containing skin substitutes would be Apligraf ® , bovine type I collagen seeded with allogeneic neonatal foreskin fibroblasts and keratinocytes; Dermagraf ® , synthetic polyglycolic or polylactic acid (PGA orPLA), ECM and allogeneic neonatal foreskin fibroblasts; or GRAFIX-Prime (viable cryopreserved placental membrane), which are clinically indicated for chronic wounds, such as diabetic foot ulcers, and partial and full thickness burns [ 36 , 37 , 38 , 39 , 40 ].…”