A Clinical Minute: Amniotic Allograft Therapy for Complex Nonhealing Wounds: A Promising Approach When Other Treatments Have Failed

  Patients referred to wound centers frequently have complex wounds and comorbidities that contribute to poor wound healing. Amniotic allografts have been used for many decades in surgical procedures and more recently in the treatment of difficult-to-heal wounds.   Because of their natural healing properties, amniotic allografts are used to support the healing process of challenging wounds. Two allograft options are AMNIOEXCEL®, an Amniotic Allograft Membrane, and AMNIOMATRIX®, an Amniotic Allograft Suspension. Both are indicated for the management of complex chronic and acute wounds. The appropriate graft type and size are selected post debridement. The membrane is applied by overlapping wound margins to facilitate epithelialization, and the suspension is applied by delivering it at positions around the wound bed.

  The following cases illustrate the use of AMNIOEXCEL® Amniotic Allograft Membrane and AMNIOMATRIX® Amniotic Allograft Suspension to help close complex wounds.

Case Reports

  Case 1. An immunocompromised patient with prior history of Stage IV non-Hodgkin’s lymphoma had undergone total body radiation, chemotherapy, and bone marrow transplant. He had a below-knee level amputation of the right leg because he had developed graft versus host tissue disease, chronic sclerodermatitis with multiple ulcers, pulmonary fibrosis, and small artery disease with chronic distal extremity ischemia. Postoperatively, the patient developed focal skin necrosis of the central portion of the amputation flap (see Figure 1). He was provided hyperbaric oxygen therapy, IV antibiotics for wound infection, and advanced wound therapy that included allograft and bilayer skin substitute, but wound healing did not progress. Because of his radiation and sclerodermatitis, he was not a good candidate for traditional skin graft. Clinicians decided to administer AMNIOEXCEL®, and after 3 applications 2 weeks apart (see Figures 2 through 4), the patient was completely closed by June 2014 (see Figure 5).

  Case 2. A 47-year-old man sustained a left foot crush injury from a forklift at work. Within 2 months, he developed a plantar sinus tract at the native tissue and free-flap tissue interface. Sharp debridement, daily wound packing, and daily flushes with saline were performed, but the sinus tract was not improving. The patient was kept nonweight-bearing, impairing physical therapy and rehabilitation, but the sinus tract was not improving with the standard of care, so AMNIOMATRIX® was applied. The first application was injected into the sinus tract(s) through the central opening that extended 1.5 cm distally and 2.3 cm proximally; the product also was injected circumferentially around the sinus tract in spiral fashion in each tunnel/tract (see Figure 6). Three weeks later, the second application was provided in a similar manner by injecting the product into the sinus tract through the central opening that extended 4 mm distally and 3 mm proximally. The wound was completely closed less than 1 month after 2 applications of AMNIOMATRIX®, and the patient was able to resume full physical therapy and full weight bearing with progression to a patellar weight-bearing prosthesis (see Figure 7).

Conclusion

  The two challenging wounds responded well to AMNIOEXCEL® Amniotic Allograft Membrane and AMNIOMATRIX® Amniotic Allograft Suspension products. Both patients were able to avoid additional surgery, and their wounds progressed to healing rapidly. Each of these patients had been treated aggressively to the extent their underlying condition allowed but were trending toward failure and amputation. The amniotic allograft demonstrated remarkable ability to help salvage complicated wounds in compromised patients where other advanced wound care modalities had previously been unsuccessful. AMNIOEXCEL® and AMNIOMATRIX® should be considered important advances in the management of complicated wounds at high risk for complications and/or amputations.

  A Clinical Minute is made possible through the support of Derma Sciences, Inc, Princeton, NJ. The opinions and statements provided in A Clinical Minute are specific to the respective authors and not necessarily those of OWM or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.