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Use of amniotic membrane transplantation in the treatment of venous leg ulcers

Authors

  • Isabelle Mermet MD,

    1. Université de Franche Comté, Department of Dermatology, University Hospital and Medical School,
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  • Nathalie Pottier MSc,

    1. Cell and Tissue Engineering Department, Etablissement Français du Sang de Bourgogne-Franche-Comté,
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  • Jean Marie Sainthillier MSc,

    1. EA 3183, Université de Franche Comté, IFR 133,
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  • Carole Malugani MSc,

    1. Cell and Tissue Engineering Department, Etablissement Français du Sang de Bourgogne-Franche-Comté,
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  • Sandrive Cairey-Remonnay MD,

    1. Université de Franche Comté, Department of Dermatology, University Hospital and Medical School,
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  • Stéphane Maddens PhD,

    1. Cell and Tissue Engineering Department, Etablissement Français du Sang de Bourgogne-Franche-Comté,
    2. Inserm U645, Université de Franche-Comté, Etablissement Français du Sang, IFR133,
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  • Didier Riethmuller MD, PhD,

    1. Université de Franche Comté, Department of Obstetrics and Gynecology, University Hospital and Medical School, and
    2. EA 3181, Université de Franche-Comté, IFR 133, Besançon, France
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  • Pierre Tiberghien MD, PhD,

    1. Cell and Tissue Engineering Department, Etablissement Français du Sang de Bourgogne-Franche-Comté,
    2. Inserm U645, Université de Franche-Comté, Etablissement Français du Sang, IFR133,
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  • Philippe Humbert MD, PhD,

    1. Université de Franche Comté, Department of Dermatology, University Hospital and Medical School,
    2. EA 3183, Université de Franche Comté, IFR 133,
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  • François Aubin MD, PhD

    1. Université de Franche Comté, Department of Dermatology, University Hospital and Medical School,
    2. EA 3181, Université de Franche-Comté, IFR 133, Besançon, France
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Reprint requests:
François Aubin, Department of Dermatology, 2 Place Saint-Jacques, 25030 Besançon, France. Tel: 33 381218483;
Fax: 33 381218482;
Email: francois.aubin@univ-fcomte.fr

ABSTRACT

Amniotic membrane (AM), the most internal placental membrane, has unique properties including antiadhesive effects, bacteriostatic, wound protection and pain-reduction properties, as well as epithelialization initialization capacities. Furthermore, AM is widely available and less costly than other bioengineered skin substitutes. In a prospective pilot study, we evaluated the safety, feasibility, and the effects on healing of AM graft in 15 patients with chronic venous leg ulcers. AM grafts were prepared from placentas harvested during cesarean section. All grafted AM had adhered to the wound bed 7 days after being applied with a 100% engraftment rate. The percentage of granulation tissue increased significantly (from 17% on day 0 to 69% on day 14, p<0.0001), along with a significant decrease of fibrinous slough (from 36% at day 0 to 16% at day 14, p<0.001). A significant clinical response occurred in 12 patients (80%) including complete healing (20%) in three during the 3-month follow-up period. The ulcer surface area decreased significantly from a mean value (±standard deviation) of 4.59±2.49 cm2 at baseline to 2.91±2.01 cm2 on day 30 (p<0.001). All patients experienced a significant reduction of ulcer-related pain rapidly after AM transplantation. No adverse events were recorded. AM transplantation seems to function as a safe substrate, promoting proper epithelialization while suppressing excessive fibrosis. Further advantages of biotherapy with AM are its easy and low-cost production, and that it can be applied as an ambulatory treatment without immobilization. AM transplantation may thus be considered to be an alternative method for treating chronic leg ulcers.

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