Sabry, M., El Sherif, A., Amr, A., Tawfik, H., Darwish, A., El Shahat, A. (2019). Evaluation of the Healing of Meshed Skin Auto Grafts of 1:3 Meshing Size Covered by Fresh Amniotic Membrane Dressings: A Prospective Multicenter Study. The Egyptian Journal of Plastic and Reconstructive Surgery, 43(2), 267-274. doi: 10.21608/ejprs.2019.65089
Mohamed Sabry; Ahmed El Sherif; Adel Hussein Amr; Heba Mohamed Tawfik; Abdou M A Darwish; Ahmed El Shahat. "Evaluation of the Healing of Meshed Skin Auto Grafts of 1:3 Meshing Size Covered by Fresh Amniotic Membrane Dressings: A Prospective Multicenter Study". The Egyptian Journal of Plastic and Reconstructive Surgery, 43, 2, 2019, 267-274. doi: 10.21608/ejprs.2019.65089
Sabry, M., El Sherif, A., Amr, A., Tawfik, H., Darwish, A., El Shahat, A. (2019). 'Evaluation of the Healing of Meshed Skin Auto Grafts of 1:3 Meshing Size Covered by Fresh Amniotic Membrane Dressings: A Prospective Multicenter Study', The Egyptian Journal of Plastic and Reconstructive Surgery, 43(2), pp. 267-274. doi: 10.21608/ejprs.2019.65089
Sabry, M., El Sherif, A., Amr, A., Tawfik, H., Darwish, A., El Shahat, A. Evaluation of the Healing of Meshed Skin Auto Grafts of 1:3 Meshing Size Covered by Fresh Amniotic Membrane Dressings: A Prospective Multicenter Study. The Egyptian Journal of Plastic and Reconstructive Surgery, 2019; 43(2): 267-274. doi: 10.21608/ejprs.2019.65089
Evaluation of the Healing of Meshed Skin Auto Grafts of 1:3 Meshing Size Covered by Fresh Amniotic Membrane Dressings: A Prospective Multicenter Study
1The Department of Plastic and Reconstructive Surgery, Minia University Hospital, Minia
2The Department of Plastic and Reconstructive Surgery, Ain Shams University Hospital
3Department of Pathology, Faculty of Medicine, Minia University
4The Department of Plastic and Reconstructive Surgery Ain Shams University Hospital Cairo
Abstract
Background: Since the development of the meshed skin grafts and the availability of different meshing expansion sizes, the sizes of the meshed skin grafts interstices like all open wounds became a problem because they increase the metabolic needs and put the patients at the risk of infection. The amniotic membrane satisfies most of the criteria for an ideal biological wound dressing to solve such a problem. Aim of Study: To determine the rate of healing of the interstices of meshed skin autograft of 1:3 meshing size applied to post burn raw areas when covered by fresh amniotic membranes. Patients and Methods: This study was conducted on 30 patients who had post burn raw areas with TBSA less than 30% divided into 2 groups Group (1): Used meshed STSG (1:3) without amniotic membrane coverage Group (2): Used meshed STSG 1:3 then covered with fresh amniotic membrane. Biopsies were taken and examined. Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate the aesthetic out come. Results: Amniotic Membrane (AM) did not improve skin graft take but it improved the macroscopic healing of the interstices which showed significant p-value 0.005* and registered valuable decrease in all items of Patient and Observer Scar Assessment Scale (POSAS) that showed significant pvalues. Also, AM accelerated the healing process histologically: The chronic inflammatory cells started to appear early (pvalue: 0.003*). In the 10th day both the maturation of the epithelium and the transformation of newly formed capillaries into mature ones showed p-values (0.006*). Conclusion: Amniotic membrane enhanced maturation of epithelium, increased the transformation of the newly formed capillaries into mature ones, accelerated the initiation of the proliferative phase of wound healing, promoted the reepithelialization of the interstices of the meshed graft and led to a better cosmetic outcome.
Alexander J.W., MacMillan B.G., Law E. and Kittur D.S.: Treatment of severe burns with widely meshed skin autograft and meshed skin allograft overlay. The Journal of Trauma, Jun., 21 (6): 433-8, 1981. 2- Smith P.D., Polo M., Soler P.M., McClintock J.S., Maggi S.P., Kim Y.J., Ko F. and Robson M.C.: Efficacy of growth factors in the accelerated closure of interstices in explanted meshed human skin grafts. The Journal of burn care & rehabilitation, Jan. 1, 21 (1): 5-9, 2000. 3- Nikkhah D., Booth S., Tay S., Gilbert P. and Dheansa B.: Comparing outcomes of sheet grafting with 1:1 mesh grafting in patients with thermal burns: A randomized trial. Burns, Mar. 1, 41 (2): 257-64, 2015. 4- Chu C.S., Matylevitch N.P., McManus A.T., Goodwin C.W. and Pruitt Jr. B.A.: Accelerated healing with a mesh autograft/allodermal composite skin graft treated with silver nylon dressings with and without direct current in rats. Journal of Trauma and Acute Care Surgery, Jul. 1, 49 (1): 115-25, 2000. 5- Parolini O., Soncini M., Evangelista M. and Schmidt D.: Amniotic membrane and amniotic fluid-derived cells: potential tools for regenerative medicine? 275-291, 2009. 6- Niknejad H., Peirovi H., Jorjani M., Ahmadiani A., Ghanavi J. and Seifalian A.M.: Properties of the amniotic membrane for potential use in tissue engineering. Eur. Cells Mater., 15: 88-99, 2008. 7- Halim A.S., Khoo T.L. and Yussof S.J.: Biologic and synthetic skin substitutes: An overview. Indian Journal of Plastic Surgery: Official publication of the Association of Plastic Surgeons of India, Sep., 43 (Suppl): S23, 2010. 8- Sheikh E.S., Sheikh E.S. and Fetterolf D.E.: Use of dehydrated human amniotic membrane allografts to promote healing in patients with refractory non healing wounds. International Wound Journal, Dec., 11 (6): 711- 7, 2014. 9- Mohammadi A.A., Sabet B., Riazi H., Tavakko-lian A.R., Mohammadi M.K. and Iranpak S.: Human amniotic membrane dressing: An excellent method for outpatient management of burn wounds. Iranian Journal of Medical Sciences, May 12, 34 (1): 61-4, 2015. 10- Dua H.S., Gomes J.A., King A.J. and Maharajan V.S.: The amniotic membrane in ophthalmology. Survey of ophthalmology, Jan. 1, 49 (1): 51-77, 2004. 11- Tanner J.C., Vandeput J.A. and Olley J.F.: The mesh skin graft. Plast. Reconstr. Surg., Sep., 34 (3): 287-92, 1964. 12- Maggi S.P., Soler P.M., Smith P.D., Hill D.P., Ko F. and Robson M.C.: The efficacy of 5% Sulfamylon® solution for the treatment of contaminated explanted human meshed skin grafts 1. Burns, May 1, 25 (3): 237-41, 1999. 13- Lin S.D., Lai C.S., Hou M.F. and Yang C.C.: Amnion overlay meshed skin autograft. Burns, Jun. 1, 11 (5): 374- 8, 1985. 14- Sakamoto M., Morimoto N., Inoie M., Takahagi M., Ogino S., Jinno C. and Suzuki S.: Cultured Human Epidermis Combined With Meshed Skin Autografts Accelerates Epithelialization and Granulation Tissue Formation in a Rat Model. Annals of Plastic Surgery, Jun., 78 (6): 651, 2017. 15- Mohammadi A.A., Jafari S.M., Kiasat M., Tavakkolian A.R., Imani M.T., Ayaz M. and Tolide-ie H.R.: Effect of fresh human amniotic membrane dressing on graft take in patients with chronic burn wounds compared with conventional methods. Burns, Mar 1, 39 (2): 349-53, 2013. 16- Mohammadi A. and Johari H.G.: Amniotic membrane: A skin graft fixator convenient for both patient and surgeon. Burns, Nov. 1, 34 (7): 1051-2, 2008. 17- Loeffelbein D.J., Rohleder N.H., Eddicks M., Baumann C.M., Stoeckelhuber M., Wolff K.D., Drecoll E., Steinstraesser L., Hennerbichler S. and Kesting M.R.: Evaluation of human amniotic membrane as a wound dressing for split-thickness skin-graft donor sites. Bio. Med. Research International, 2014. 18- Gonzalez A.C., Costa T.F., Andrade Z.D. and Medrado A.R.: Wound healing-A literature review. Anais brasileiros de dermatologia, Oct., 91 (5): 614-20, 2016. 19- Draaijers L.J., Tempelman F.R., Botman Y.A., Tuinebreijer W.E., Middelkoop E., Kreis R.W. and Van Zuijlen P.P.: The patient and observer scar assessment scale: A reliable and feasible tool for scar evaluation. Plastic and Reconstructive Surgery, Jun. 1,113 (7): 1960-5, 2004. 20- Van De Kar A.L., Corion L.U., Smeulders M.J., Draaijers L.J., Van Der Horst C.M. and Van Zuijlen P.P.: Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale. Plastic and reconstructive surgery, Aug. 1, 116 (2): 514-22, 2005. 21- Bianchi F.A., Roccia F., Fiorini P. and Berrone S.: Use of Patient and Observer Scar Assessment Scale for evaluation of facial scars treated with self-drying silicone gel. Journal of Craniofacial Surgery, May 1, 21 (3): 719-23, 2010.