Effect of Human Amniotic Membrane Application on Microskin Graft | ||||
Minia Journal of Medical Research | ||||
Article 10, Volume 36, Issue 1, January 2025, Page 75-83 PDF (589.74 K) | ||||
Document Type: Original Article | ||||
DOI: 10.21608/mjmr.2024.297542.1727 | ||||
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Authors | ||||
Ahmed Mohamed Saeed ![]() | ||||
Department of Plastic Surgery, Faculty of Medicine, Minia University, Egypt | ||||
Abstract | ||||
Background; Severe full-thickness burns and significant injuries that cause extensive skin damage hinder natural regeneration and jeopardize patient survival. Immediate coverage is essential to restore normal skin function. When a donor site is available, using an autograft is always the preferred and most effective option. Aim and objectives; To assess the impact of applying human amniotic membrane at the recipient site of micro-autogenous split-thickness skin grafts for covering post-burn raw areas, this study focuses on several factors: the graft take percentage, infection rates, time required for complete wound healing, the expansion ratio of the recipient site to the graft donor site, and the scar evaluation of the graft. Subjects and methods; This prospective controlled clinical study was conducted on 20 patients at the Plastic Surgery Department of Minia University Hospitals. The study involved applying human amniotic membrane to the recipient site of micro-autogenous split-thickness skin grafts on only one half of the raw area, with the other half serving as a control. Results; The mean time for complete healing in study side which is covered by amniotic membrane is (25.5±4.2), and it is significantly lower than the control side which is not covered by amniotic membrane which is (30.8±5). No need for another session of grafting at both sides. | ||||
Highlights | ||||
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Keywords | ||||
Microskin graft (MSN); Split Thickness Skin graft (STSG); Amniotic Membrane (AM) | ||||
Full Text | ||||
Introduction Severe full-thickness burns or major injuries that severely damage the skin can impede natural regeneration and threaten patient survival. Prompt intervention is crucial to restore normal skin function. When donor skin is available, an autograft is widely regarded as the most effective solution [1].
Skin grafts are primarily classified into three basic types: full-thickness skin grafts (FTSG), split-thickness skin grafts (STSG), and composite grafts. FTSGs include both the epidermis and the entire thickness of the dermis. In contrast, STSGs comprise the entire thickness of the epidermis and only a portion of the dermis, and they can be further subdivided into thin, medium, and thick grafts [2].
The healing process of skin grafts typically involves three stages: anchorage, inosculation, and maturation. While split-thickness autografts are preferred, the limitation of available donor sites has driven the search for alternative solutions [3].
Converting both split and full-thickness grafts into micrografts transforms them into individual units that promote regeneration and release growth factors to support the healing process [4].
Microskin grafts (MSG) are thin split-thickness grafts that come in different sizes and thicknesses. Smaller grafts tend to heal faster because they have more active edges, which accelerate regeneration [5].
Cells in the basal layer of microskin form epithelial islands that expand outward, connecting to the wound surface's epidermis and creating an epidermal cyst structure. Autologous micrografts are rich in progenitor cells, growth factors, and extracellular matrix particles derived from the patient's own tissue [6].
The amniotic membrane (AM), which is the innermost part of the placenta, has been used in therapeutic applications for the past century. Its thickness ranges from 0.02 mm to 0.5 mm and it is composed of three primary histological layers: the epithelial layer, the thick basement membrane, and the avascular mesenchymal tissue [7].
Applying an amniotic membrane in burn treatment promotes rapid healing and re-epithelialization by mitigating several harmful factors. Covering microskin grafts with a hu-man amniotic membrane accelerates wound [8].
The amniotic membrane significantly shortens the duration for complete graft take, making it especially suitable for children or burns on the extremities. The graft is applied to the wound bed, and the amniotic membrane is wrapped around the grafted extremity, followed by dressing. The membrane adheres to itself when wrapped around the extremity. Using an amniotic membrane as a graft fixator is associated with accelerated re-epithelialization and recovery [9].
Aim of the work To assess the impact of applying human amniotic membrane at the recipient site of micro-autogenous split-thickness skin grafts for covering post-burn raw areas, as regard to:
Patient and Methods
This prospective controlled clinical study was conducted on 20 patients at the Plastic Surgery Department of Minia University Hospitals. The study involved the application of human amniotic membrane at the recipient site of micro-autogenous split-thickness skin grafts.
Inclusion Criteria:
Exclusion Criteria:
All patients will be subjected to:
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