Limb Salvage: Dehydrated Human Amnion/Chorion Membrane Allografts (dHACM) Used in Combination with Decellularized Human Collagen Matrix (dHCM) Can Prevent the Necessity for Amputations

Placental amniotic membrane has been used as wound dressing for more than 100 years. Burn and traumatic limb injuries with exposed bone/tendon require surgical flaps or amputations for healing. Currently, technology has revolutionized the development of biological wound dressings for clinical use.

The PURION® Processed dHACM is cleansed/dehydrated from donor-screened/tested elective Caesarean-section-delivered placentas. With the inclusion of both the amnion/chorion, dHACM contains nonviable cells plus 285 identified regulatory proteins which include growth factors, chemokines, cytokines, tissue inhibitors of metalloproteinases (TIMPS) and other proteins necessary for tissue growth/regeneration, decrease of inflammation, and stem cell stimulation for tissue healing. dHACM has been successfully used as a dressing for wound ulcers, partial-/full-thickness burns, donor sites, and surgical debridement. dHCM is derived from the placental disc and contains mostly type 1 human collagen.

This is a retrospective three case study of severe lower extremity tissue injury with bone/tendon exposure, which would normally require aggressive reconstructive procedures or a lower limb amputation. dHACM/dHCM was spread over or packed (depending on wound depth), then covered with 3% bismuth tribromophenate petrolatum dressing and glycerol/ hydroxyethylcellulose lubricant. Negative pressure wound therapy (NPWT) was initiated and the wound was re-evaluated in seven days for tissue response. dHACM/dHCM was reapplied into/on the wound if required for good granulation tissue (bone still exposed to a smaller degree but further treatment with dHACM/dHCM necessary). Before autograting, an extra boost of injectable, micronized form of mdHACM was applied onto the wound edges. Patients healed after 2–3 dHACM/dHCM applications and did not require leg or foot amputations.

All three patients recovered well with good results and no complications. In select limb salvage cases, dHACM/HCM may be a promising alternative to extremity amputations, tissue transfer flaps, or other techniques for secondary intention healing of wounds with bone/tendon exposure.