Use of dehydrated human amniotic membrane allografts to promote healing in patients with refractory non healing wounds

Emran S Sheikh, Ednan S Sheikh, Donald E Fetterolf, Emran S Sheikh, Ednan S Sheikh, Donald E Fetterolf

Abstract

Non healing wounds present a significant social and economic burden. Chronic non healing wounds are estimated to affect as many as 1-2% of individuals during their lifetime, and account for billions of dollars of expense annually on both a national and global basis. Our purpose is to describe the use of a novel dehydrated amniotic membrane allograft (EpiFix(®) ; MiMedx Group, Inc., Kennesaw, GA) for the treatment of chronic non healing wounds. We describe the results of EpiFix treatment in four patients who had not achieved wound closure with both conservative and advanced measures, and had been referred for a definitive plastic surgery procedure. Healing was observed in a variety of wounds with one to three applications of the dehydrated amniotic membrane material. The material was well tolerated by patients. Healed wounds did not recur in long-term follow-up. Further investigation of the use of dehydrated amniotic membrane in broader application to various types of dermal wounds should be considered.

Keywords: Allograft; Amniotic membrane; Wound treatment.

© 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
A 3‐week‐old wound showing a postoperative dehiscence after left olecranon bursa excision.
Figure 2
Figure 2
A 10‐week‐old wound at 3 weeks post single application of dHAM.
Figure 3
Figure 3
A graph plotting wound size over time (red line represents application of dHAM on 1 September 2010). Area is in square cm, volume is in cubic cm. Both parameters improved until resolution from the plateau seen before dHAM application.
Figure 4
Figure 4
Initial wound of the anterior knee.
Figure 5
Figure 5
Image showing dHAM application on wound, 14 weeks post‐injury.
Figure 6
Figure 6
Healing rate in case 2. Amniotic membrane was applied three times at 14 weeks (17 March), 20 weeks (22 April) and 25 weeks (27 May) (red line represents application of dHAM). Area is in square cm, volume is in cubic cm. Both parameters improved until resolution from the plateau seen before dHAM application.
Figure 7
Figure 7
Image showing 25 weeks post‐injury, after three applications of dHAM.
Figure 8
Figure 8
Image showing 4 weeks (4 March 2010) postoperative wound.
Figure 9
Figure 9
Amniotic membrane application initiated at 15 weeks. Note the exposed tendon present.
Figure 10
Figure 10
A 17‐week wound (1 June 2010) 2 weeks after application of dHAM.
Figure 11
Figure 11
Healing rate graph for wound in case 3 (red line represents application of skin graft on 1 April, and dHAM on 20 May, 2 June and 23 June). Area is in square cm, volume is in cubic cm.
Figure 12
Figure 12
Image showing a wound 4 months after ankle ORIF.
Figure 13
Figure 13
Wound treated with dHAM application as on 1 September 2010.
Figure 14
Figure 14
Image showing a wound 8 weeks after dHAM application.
Figure 15
Figure 15
Healing rate graph for wound in case 4 (red line represents application of dHAM on 1 September 2010). Area is in square cm, volume is in cubic cm.

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