References

Ogawa R. An overview of the pathogenesis, prevention and treatment of keloids. Eur Surg. 2012; 44:(2)85-90 https://doi.org/10.1007/s10353-011-0065-4

Chike-Obi C, Cole P, Brissett A. Keloids: pathogenesis, clinical features, and management. Semin Plast Surg. 2009; 23:(03)178-184 https://doi.org/10.1055/s-0029-1224797

Bloom D. Heredity of keloids; review of the literature and report of a family with multiple keloids in five generations. N Y State J Med. 1956; 56:(4)511-519

Shaffer JJ, Taylor SC, Cook-Bolden F. Keloidal scars: A review with a critical look at therapeutic options. J Am Acad Dermatol. 2002; 46:S63-S97 https://doi.org/10.1067/mjd.2002.120788

Wolfram D, Tzankov A, Pülzl P, Piza-Katzer H. Hypertrophic scars and keloids—a review of their pathophysiology, risk factors, and therapeutic management. Dermatol Surg. 2009; 35:(2)171-181 https://doi.org/10.1111/j.1524-4725.2008.34406.x

Nast A, Eming S, Fluhr J German S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids). JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2012; 10:(10)747-760 https://doi.org/10.1111/j.1610-0387.2012.08012.x

Nemeth AJ. Keloids and hypertrophic scars. J Dermatol Surg Oncol. 1993; 19:(8)738-746 https://doi.org/10.1111/j.1524-4725.1993.tb00418.x

Duerr RA, Ackermann J, Gomoll AH. Amnioticderived treatments and formulations. Clin Sports Med. 2019; 38:(1)45-59 https://doi.org/10.1016/j.csm.2018.08.002

John T. Human amniotic membrane transplantation: past, present and future. Ophthalmol Clin North Am. 2003; 16:(1)43-65 https://doi.org/10.1016/S0896-1549(02)00110-4

Cornwell KG, Landsman A, James KS. Extracellular matrix biomaterials for soft tissue repair. Clin Podiatr Med Surg. 2009; 26:(4)507-523 https://doi.org/10.1016/j.cpm.2009.08.001

Sawhney CP. Amniotic membrane as a biological dressing in the management of burns. Burns. 1989; 15:(5)339-342 https://doi.org/10.1016/0305-4179(89)90015-6

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Clinical/pre-clinical research
Hard-to-heal wounds

Amniotic and umbilical cord particulate in the management of keloid and hypertrophic scars

02 July 2019
Practice
02 July 2019
Volume 3 · Issue 3

Abstract

Objective:

To examine the efficacy of using amniotic membrane and umbilical cord products in the management of keloid and hypertrophic scars.

Methods:

A single-centre, retrospective case series of patients who developed keloids or hypertrophic scars (size range: 3–30cm). Each patient had their keloids excised or hypertrophic scar debrided followed by application of amniotic membrane and umbilical cord particulate matrix and/or amniotic membrane and umbilical cord membrane. Wounds were then closed primarily and wound healing was evaluated.

Results:

All eight patients (one male, seven females) presented with keloids or hypertrophic scars that had not healed for 30.6 months. The scars were excised resulting in an average wound size of 16.3±14.2cm. After amniotic membrane and umbilical cord treatment, patients demonstrated complete wound healing in <3 months with superior aesthetic outcomes. All patients healed with minimal or no scarring and no recurrence of keloid. There were no complications, such as infection or dehiscence.

Conclusion:

This findings of this limited study suggest these immunomodulatory products could be used in a variety of wound care applications. The role of these products in chronic wound management is still evolving. Larger, high-quality studies are needed to consistently demonstrate the efficacy of these products.

When skin undergoes an abnormal wound healing process following deep skin injury, pathological scars such as keloids and hypertrophic scars can arise, resulting in a fibroproliferative disorder of the skin.1 The scars are commonly red and elevated and have an unappealing appearance that may result in limited function if overlying a tendon or joint, have a sociopsychological impact on the patient, and reduce their quality of life (QoL). These scars are also known to be associated with severe pain, itching and contraction sensations and frequently occur in people with darker skin, being 15 times more common than in those with lighter complexion.2,3

Historically, several methods and procedures have been proposed to either decrease the size of these scars or potentially achieve a more cosmetically acceptable scar such as surgical excision, intralesional steroids, antihistamines, cryotherapy, laser removal, radiotherapy and immunomodulators. However, the success of these methods has been variable.4

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amniotic membrane
chronic wound
keloid
umbilical cord
particulate