Investigating The Wound Healing Potential Of A New Amniotic Membrane Graft

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Eric J. Lullove, DPM, CWS, FACCWS

This author discusses how the use of an innovative human amniotic membrane graft enhanced healing in three patients with lower extremity wounds.

Homologous tissue in wound healing has been in use for many years and recently human amnion-derived materials have become available to clinicians. Amniotic membrane derived allografts that consist of a dehydrated composite of amniotic and chorionic membranes are particularly interesting as they combine layers of the amniotic membrane that are both subjects of intensive research.

   These membranes are isolated from donor placentas and then have minimal processing in order to cleanse and disinfect tissue. The disinfection process is designed to maintain the structural properties and composition of the extracellular matrix, and preserve the inherent sensitive biomaterial components. One can use such carefully isolated human allografts as temporary covers for wounds until they progress to epithelialization and closure.

   The following case studies demonstrate the use of a placental tissue, Revitalon Amniotic Membrane (Medline Industries). This tissue is unique in that it is processed aseptically and contains both the amnion and chorion components of the amniotic membrane. I chose difficult to heal wounds on the lower extremity for this case report. It is important to note that the presence of severe vascular compromise, active or latent infection, or uncontrolled infection at the wound site may compromise the usefulness of the tissue.

   I chose and managed the following three patients with single or repeated applications of a human amniotic membrane (Revitalon) allograft. Wound bed preparation was the same in all cases. I performed tangential en bloc debridement of a full-thickness nature with excision of all non-viable tissue to a healthy bleeding wound bed to get the wound bed ready for the application of amniotic membrane.

Case Study One: Treating An Open Wound At The First MPJ

A 75-year-old female initially presented on July 9, 2013 in the hospital for consultation for possible debridement of an open wound to the right great toe joint. An orthopedic surgeon initially saw her on July 6 and performed a bedside I&D and packed the wound with ORC collagen.

   The patient’s past medical history is pertinent for chemotherapy for acute myeloid leukemia, type 2 diabetes, coronary artery disease, hypertension and gout. She had been taking colchicine (Colcrys, Takeda Pharmaceuticals), acetaminophen/codeine (Tylenol #3, McNeil Consumer Healthcare), glipizide (Glucotrol, Pfizer), NovoLog (Novo Nordisk) per a sliding scale, lisinopril (Prinivil, Merck) and methylprednisolone (Solu-Medrol, Pfizer). She had no allergies and did not smoke or drink.

   The wound initially measured 2.0 cm x 2.5 cm x 0.2 cm and was dorsal to the first metatarsophalangeal joint (MPJ) on the right foot. Cellulitis was present with slough to the wound bed. Pulses were palpable +2/4 bilaterally. There was no focal defect loss. Distal symmetric loss of protective sensation was present bilaterally.

   I performed wound debridement on July 12. Negative pressure wound therapy initiated in-hospital. She had a normal postoperative course after debridement with primary closure. I sent the patient to a skilled rehab facility for postoperative management.

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