Evaluation of the Healing of Meshed Skin Auto Grafts of 1:3 Meshing Size Covered by Fresh Amniotic Membrane Dressings: A Prospective Multicenter Study

Document Type : Original Article

Authors

1 The Department of Plastic and Reconstructive Surgery, Minia University Hospital, Minia

2 The Department of Plastic and Reconstructive Surgery, Ain Shams University Hospital

3 Department of Pathology, Faculty of Medicine, Minia University

4 The 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.

Keywords

Main Subjects

References

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.

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