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.