References

Zelen CM, Serena TE, Denoziere G. Fetterolf DE. A prospective randomized comparative parallel study of amniotic membrane wound graft in the management of diabetic foot ulcers. Int Wound J. 2013; 10:(5)502-507

Sheikh E.S., Sheikh E.D., Fetterolf D.E. Use of dehydrated human amniotic membrane allografts to promote healing in patients with refractory non healing wounds. Int Wound J. 2014; 11:(6)711-717

Turhan V., Mutluoglu M, Acar A Increasing incidence of gram-negative organisms in bacterial agents isolated from diabetic foot ulcers. J Infect Dev Ctries. 2013; 7:(10)707-712

Koob TJ, Rennert R, Zabek N Biological properties of dehyrdrated human amnion/chorion composite graft: implications for chronic wound healing. Int Wound J. 2013; 10:(5)493-500

John T. Human amniotic membrane transplantation: past, present, and future. Opthalmol Clin North Am. 2003; 16:(1)43-65

Willett NJ, Thote T, Lin AS Intra-articular injection of micronized dehydrated human amnion/chorion membrane attenuates osteoarthritis development. Arthritis Res Ther. 2014; 16:(1)

Tay E, Utine CA, Akpek EK. Crescenteric amniotic membrane grafting in keratoprosthesis-associated corneal melt. Arch Ophthalmol. 2010; 128:(6)779-782

Mehta M, Waner M, Fay A. Amniotic membrane grafting in the management of conjunctival vascular malformations. Ophthal Plast Reconstr Surg. 2009; 25:(5)371-375

Maan ZN, Rennert RC, Koob TJ. Cell recruitment by amnion chorion grafts promotes neovascularization. J Surg Res. 2015; 193:(2)953-962

Serena TE, Carter MJ, Le LT A multicenter, randomized, controlled clinical trial evaluating the use of dehydrated human amnion/chorion membrane allografts and multilayer compression therapy vs. multilayer compression therapy alone in the treatment of venous leg ulcers. Wound Repair Regen. 2014; 22:(6)688-693

Zelen CM, Gould L, Serena TE A prospective, randomised, controlled, multi-centre comparative effectiveness study of healing using dehydrated human amnion/chorion membrane allograft, bioengineered skin substitute or standard of care for treatment of chronic lower extremity diabetic ulcers. Int Wound J. 2014; https://doi.org/10.1111/iwj.12395

Sheenan P, Jones P, Caselli A Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care. 2003; 26:(6)1879-1882

Diabetic foot ulcers
Hard-to-heal wounds
Clinical/pre-clinical research

Dehydrated human amnion/chorion tissue in difficult–to-heal DFUs: a case series

02 May 2021
Practice
02 May 2021
Volume 5 · Issue 2

Abstract

Diabetic foot ulcers (DFUs) occur as a result of multifactorial complications and are commonly found in the diabetic community. Underlying disease states such as neuropathy and peripheral vascular disease can slow healing rates, potentially leading to recurrence, amputation, and increased mortality. As with many other disease processes, DFUs have several treatment options, such as debriding agents, alginate seaweed extract, hydrocolloid gels, and amniotic membrane allografts. The presented cases all used a dehydrated human amniotic/chorionic membrane allograft (dHACM; EpiFix) to aid the healing process. Human amniotic epithelial membranes have seen increased usage due to their ability to enhance the healing process and accelerate cellular regeneration. The DFUs healed in all of the five patients treated, and patients saw a full recovery in 2.5–11 weeks. In addition, the healing time decreased in spite of the non-adherence seen in three of the patients. These results suggest another possible use for dHACM; however, further studies are required to confirm these data.

The development of diabetic foot ulcers (DFUs) is thought to result primarily from either peripheral arterial disease or peripheral neuropathy, in addition to other factors such as deformity, callus, and trauma.1,2 Infected DFUs are associated with significant mortality and are the leading cause of non-traumatic lower extremity amputations.3

While controlled blood sugar and skin maintenance are mainstays in prevention, wound healing can be aided with debriding agents, alginate seaweed extract, Hydrofiber pads, polyurethane foam, hydrogels, transparent films, hydrocolloid gels, or dehydrated human amniotic/chorionic membrane allograft (dHACM). If these therapies fail in complex wounds other possible treatments include negative pressure wound therapy (NPWT), hydrotherapy, and surgical management.4

Human amniotic epithelial membranes are thought to serve three major functions:

Their use has been limited as it was previously very difficult to acquire and effectively produce readily available human amniotic membranes. However, the development of stabilised and preserved dHACM led to its approval as a tissue allograft option in wound care.2 In previous studies it has been successfully used to treat many other conditions, including osteoarthritis, keratoprosthesis implantation, and conjunctival vascular malformations.6,7,8

Register now to continue reading

Thank you for visiting Wound Central and reading some of our peer-reviewed resources for wound care professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Access to clinical or professional articles

  • New content and clinical updates each month

Register
Or continue by

Signing in with your registered email address

diabetic foot ulcers
dehydrated human amniotic/chorionic membrane
allograft
chronic wounds